Digital Commons Network^™

The Integration Of Transgender Health Into Jeffmd, Jacob Nair, Bernard Lopez, Md

Phase 1

Purpose: One way to address healthcare disparities experienced by the transgender community is by educating medical students on trans health. Currently, there is not a universal LGBTQ+ curriculum in medical schools, which has resulted in students feeling incompetent and uncomfortable when treating transgender patients. The purpose of this study was to evaluate the current trans health content in JeffMD and remedy any curricular gaps with trans specific content.

Methods: The trans content in JeffMD was identified using a Keyword Search tool, One45 and lecture notes. A survey distributed to all Thomas Jefferson healthcare students regarding their attitudes and knowledge surrounding …

Impact Of Covid-19 On Individuals With Opioid Use Disorder’S Access To Services And Substance Use, Camryn Bernheimer, Lara Weinstein, Md

Phase 1

Introduction: The opioid epidemic has already devastated Philadelphia and COVID-19 has the potential to exacerbating this existing crisis. The goal of this study is to investigate how COVID-19 has impacted Medication Assisted Treatment (MAT) service utilization and substance use for individuals with opioid use disorder (OUD).

Methods: 170 participants with OUD in group-based MAT programs in Philadelphia were analyzed three months prior to and after COVID-19. The data provided participant age, gender, race/ethnicity, MAT visits, primary care physician (PCP) visits, behavioral health consult visits (BHC), and urine drug screen (UDS) results from health records. Pre-post COVID-19 relationships were examined …

Impact Of A Multidisciplinary Group On Management Of Patent Foramen Ovale In Cryptogenic Stroke And Outcome Measures: A Retrospective Study, Laura Meissner, Diana L. Tzeng, Md

Phase 1

Patent foramen ovale (PFO) is a common cardiac abnormality present in roughly 25% of the adult population. Although typically benign, patients with a PFO account for 50% of the population of cryptogenic stroke, an ischemic stroke with an unknown cause. Guidelines suggest closure in patients with a cryptogenic stroke found to have a PFO; however, it is unclear whether medical treatment should be given to all patients, regardless of PFO closure, and data is limited on the treatment outcomes. This retrospective chart analysis of 80 patients with a cryptogenic stroke found to have a PFO will investigate the criteria a …

Improving The Implementation Of Home Blood Pressure Monitoring, Joshua Mairose, Geoffrey Mills, Md

Phase 1

Introduction: Home blood pressure monitoring (HBPM) has been shown to outperform traditional office readings in its association with cardiovascular disease (CVD) risk and ability to identify patients with white coat or masked hypertension. For these reasons, the 2017 ACC/AHA Guidelines included HBPM as part of its recommendations for hypertension management. Our project focused on improving the implementation of HBPM in an urban primary care practice with an end goal of increasing the number of patients that actively use home blood pressure cuffs and have access to them for future telemedicine visits.

Methods: A patient outreach process to increase HBPM uptake …

Race And Disordered Eating: A Narrative Review Of Current Literature, Casey Swann, Msed, Lee Pachter, Do, Elizabeth Liveright, Md, Meghan Gannon, Phd, Msph

Phase 1

Research Problem: Eating disorder literature has well-established a correlation between childhood trauma and development of eating disorder symptomology. One type of trauma that is often overlooked in eating disorder research is that of racial stress faced by ethnic minorities. The literature on racism and eating disorders tends to focus on the transdiagnostic construct of disordered eating behavior rather than specific DSM-5 diagnoses. As such, the current literature review examined the findings regarding associations between racial stressors and disordered eating behavior.

Methods: The current literature review between Nov 2007 and August 2020 searched 3 databases, PubMed, CINAHL, and PsycInfo for …

Primary Care Obstructive Sleep Apnea Screening, Grant Gillan, Ben Espenhorst, Cynthia Cheng

Phase 1

Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by long pauses in breathing over the course of a night’s sleep, leading to significant daytime fatigue and long-term pathologies if left untreated. While a sleep study is the diagnostic tool of choice for OSA, this test is costly. To maximize cost effectiveness, we developed a screening protocol to identify patients at high risk for OSA for referral for a sleep study.

To identify high risk individuals, we screen patients identified in the EMR with pre-existing risk factors of OSA. We contact them to complete the full screening test: the …

Patient Characteristics Of A Primary Care-Based Medication-Assisted Treatment Program For Opioid Use Disorder In Philadelphia, Zoe Wong, Lara Weinstein, Md

Phase 1

Introduction: The opioid crisis is a persistent national public health concern, with Philadelphia at its epicenter. Medication-assisted treatment (MAT) programs for opioid use disorder in primary care settings afford greater access to marginalized groups and integration of healthcare services. This study describes patient characteristics of a low-threshold, primary care-based MAT program in Philadelphia.

Methods: 134 patient interviews between February 12, 2019 and March 14, 2020 were retrospectively analyzed. Key characteristic measures included drug and alcohol use history, co-occurring health conditions, history of violence or trauma, and quality of life. The results from the two program locations, Stephen Klein Wellness Center …

Menstrual Management In Adolescent Transgender Males, Julia Eisenberg, Sarah Felleman, Benjamin Bear, Mph, Arielle Effron, Md, Anne Kazak, Phd, Abpp, Anthony Alioto, Phd, Evan Graber, Do, Vanessa Short, Phd, Mph, Meghan Gannon, Phd, Msph, Beth Schwartz, Md

Phase 1

Introduction: Gender dysphoria is associated with increased rates of anxiety, depression, and suicidal ideation in adolescents. There is anecdotal evidence that menstruation increases the occurrence of gender dysphoria in adolescent transgender males. We hypothesize that menses are distressing to transgender males and this population would benefit from menstrual management.

Methods: We conducted a retrospective chart review of all transgender male patients seen in the Nemours Gender Wellness Program (GWP) and limited our population to those who have reached menarche. Data was extracted from the encounters at the GWP clinic and recorded in REDCap. We compared self-reported symptoms of gender dysphoria …

A Single Academic Center's Experience With Direct Access Colonoscopy, Rachel Israilevich, Mary White, Sophia Lam, Benjamin Chipkin, David Kastenberg, Md

Phase 1

Introduction: Direct Access Colonoscopy (DAC) does not require pre-colonoscopy consultation and may improve access for patients needing screening and surveillance. DAC eligibility criteria vary widely, and we developed a novel, DAC program using EMR patient data to assess appropriateness for inclusion. This study aimed to evaluate the efficacy and quality of our DAC program and compare to traditional, Office-Scheduled Colonoscopy (OSC).

Methods: We conducted a retrospective, single-center study of OSC and DAC patients ages 45-75 with a screening or surveillance indication over 13 months. Primary outcome was Complete Colonoscopy (CC): to cecum/ileum/anastomosis, adequate prep, < 90 days from gastroenterology contact. Patients not meeting CC criteria were classified as Incomplete Colonoscopy (IC). Secondary endpoints: time to CC, adenoma detection rate (ADR).

Results: 2,651 patients met …

Comparative Observational Study For Bifurcating Aneurysm Treatment; Open Versus Endovascular Approaches And Classical Versus New Techniques., Samuel Fallon, Ahmad Sweid, Md, Nikolaos Mouchtouris, Md, Michael Reid Gooch, Md, Pascal Jabbour, Md

Phase 1

Introduction: Aneurysm occur in approximately 3.2% of the population with a mean age of 50 years, a 1:1 gender ratio, and an estimate mortality rate of 70%. Aneurysms develop at branch points with elevated intravascular turbulence and vessel wall shear stress. we aim to compare the efficacy and safety of different surgical treatment modalities for bifurcating intracranial aneurysms.

Methods: A retrospective review of 398 patients who underwent surgical management of a bifurcating aneurysm at Thomas Jefferson University hospital from 2010 to 2020. Aneurysm size, location, modality of treatment, and treatment complications were assessed.

Results: Data analysis is expected to …

Celiac Disease: Clinical-Pathological Correlation In 100 Consecutive Patients, Michael J. Dimarino, Sidney Cohen, Md, Stephanie Moleski, Md, Christopher Cao, Md, Michael C. Dimarino, Md, Anthony Dimarino, Md

Phase 1

Introduction: Celiac Disease (CD) is an autoimmune disease that manifests as inflammation in the small intestine that can be measured by both serology (tTG-IgA) and pathology (Marsh scores). Despite having two clear etiologies defining the disease, the relationship between these markers and the clinical presentation is unclear but the age at presentation has thought to be correlated with a worsened pathology.

Methods: This was a retrospective chart review at Thomas Jefferson University Hospital (TJUH). The study consisted of patients diagnosed with Celiac Disease at TJUH with both a Marsh score and a tTG-IgA antibody result. Analysis via correlation statistics …

Prevalence And Risk Factors For Abnormal M-Tics, Maëlys Yepes, Michael Chang, Cynthia Cheng, Md, Phd

Phase 1

Introduction: The lack of effective treatments for Alzheimer’s Disease (AD) underscores the importance of prevention and early detection of amnestic mild cognitive impairment (aMCI), its prodromal state. While studies have proposed a number of potential mechanisms underlying the pathogenesis of AD, such as hypoxia and neuropsychiatric symptoms, little research has been done to evaluate predictive risk factors.

Objective: The objective of this pilot study is to assess the prevalence and risk factors for aMCI.

Methods: This cross-sectional study was performed using data from patients screened for Memories 2, a clinical trial evaluating the effect of CPAP usage in patients with …

A Virtual Educational Intervention Addressing Weight Bias In Medical Students, Gina Goldberg, Joseph Majdan, Md

Phase 1

Introduction:

Individuals with higher body weight experience severe and pervasive discrimination in nearly every walk of life. Stigmatizing treatment from healthcare providers increases anxiety, depression, body dissatisfaction and risk of weight gain while decreasing the likelihood that patients will seek preventative or emergency care. This study assessed whether a virtual session exploring obesity, which included the personal testimony of a Physician Professor with obesity, positively influenced the explicit attitudes and implicit biases of medical students towards people with higher body weight.

Methods:

SKMC medical students completed an Implicit Associations Test (IAT), a Universal Measure of Bias (UMB) and a …

Housing First For People With Opioid Use Disorder (Oud) And Engagement With Medication-Assisted Treatment (Mat) And Harm Reduction Services, Husayn Siddiqui, Ashley Katzenstein, Lara Weinstein, Md, Drph

Phase 1

Intro: Opioid Use Disorder (OUD)is one of the most prevalent and deadly SUD’s in the country and many barriers exist for individuals living with homelessness and concurrent psychiatric illnesses when hoping to engage in Medication-Assisted-Recovery/Treatment (MAR/MAT). The current study evaluates the Pathways to Housing PA’s (PTHPA) Housing First(HF) model which provides scatter-site housing with social and maintenance services to individuals with a history of chronic homelessness and a diagnosis of OUD.

Methods: A retrospective chart analysis was completed for to assess factors relating to MAT engagement using PTHPA’s Credible BH recording system. MAT engagement prior to HF, psychiatric, homelessness, and …

Motivational Interviewing For Cpap Adherence, Grayton Downing, Caitlin Green, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Untreated obstructive sleep apnea (OSA) leads to negative health outcomes. Yet, compliance rates for continuous positive airway pressure (CPAP), the gold standard of treatment, range from 30-60%. This study examines how motivational interviewing (MI), a goal-oriented form of psychotherapy, increases CPAP adherence. We hypothesize that MI increases CPAP compliance when incorporated into CPAP follow-up care.

Methods: We developed and trained our staff with a novel MI training protocol consisting of MI background readings and videos, CPAP technician shadowing, and MI role-play for certification. For the clinical trial, newly diagnosed OSA patients from Jefferson’s sleep center will be randomized …

The Effect Of Reflection Rounds On Medical Students’ Empathy, Erica Westlake, Jennifer Desantis, Med, Fred Markham, Md

Phase 1

Background: A decline in empathy has been noted in medical students in medical education and training. This decline raises concerns because empathic physician-patient interactions positively impact health outcomes and patient satisfaction. We tested the hypothesis that Reflection Rounds would increase empathy scores of third-year medical students.

Methods: Third-year students entering their Family and Community Medicine (FCM) clerkship completed the Jefferson Physician Scale of Empathy – Student Version (JPSE-S) at the onset of their clerkship; students at the Jefferson Campus site were assigned to the experimental group and students at Affiliate Sites were assigned to the control group. The experimental group …

Assessing Student Opinion On Autopsy As A Supplement To Medical Education, Wing Fei Wong, Joanna Chan, Md

Phase 1

Purpose: Medical schools in the United States have decreased use of autopsy as a teaching tool in undergraduate medical education (UME). However, there are no recent data to understand how undergraduate medical students (UMS) value autopsies in their education, thus limiting suggestions for improving UME. This study aims to assess UMS opinion regarding autopsies as a supplement to their medical curriculum: is autopsy important and how?

Methods: This was a questionnaire study targeted to UMS at Sidney Kimmel Medical College. The questionnaire contained 51 closed- and open-ended questions (e.g. multiple choice, Likert scale, free response), and was distributed electronically. Data …

Characteristics Of A Food Insecure Population In North Philadelphia, Galicano Kai Inguito, James Gardner, Laura Layer, Karen Fritz

Phase 1

Introduction: A 2018 report by Hunger Free America showed that food insecurity increased in Philadelphia by 22%, even though it decreased nationally. The objectives of this study were to perform food insecurity screens, and to describe the demographic characteristics in terms of age, gender, primary language, body mass index (BMI), and zip code. We hypothesized that older, overweight, Hispanic females would be more likely to be food insecure.

Methods: After obtaining consent, the validated Hunger Vital Sign screening tool was used in the Summer of 2019 in North Philadelphia by teams of trained students in the Summer Medical Institute program. …

Mechanical Thrombectomy In Acute Ischemic Stroke Patients Greater Than 90 Years Of Age Experience In 26 Patients In A Large Tertiary Care Center: Outcome Comparison With Younger Patients, Nicholas Elmer, Ahmad Sweid, Md, Joshua H. Weinberg, Vivian Xu, Kavya Shivashankar, Tyler D. Alexander, Ms, Jane Khalife, Md, Michael R. Gooch, Md, Nabeel Herial, Md, Nohra Chalouhi, Md, Pascal Jabbour, Md, Robert H. Rosenwasswer Md, Stavropoula Tjoumakaris, Md

Phase 1

Introduction: Several independent randomized control trials have shown the superior efficacy of mechanical thrombectomy for acute ischemic stroke (AIS). However, the elderly has been underrepresented or excluded in these trials. In this study, we investigated the feasibility and safety of mechanical thrombectomy in patients with AIS aged 90 years or greater.

Methods: A retrospective review of patients age 90 years or older presenting with AIS who underwent mechanical thrombectomy between 2010 and 2018.

Results: Of total 453 patients with AIS, 5.74 % (26) were aged 90 or older, and 69.32 % (314) ranged from 60-89 years of age. Of …

A Report From The Grndad Multi-Site Registry For Sickle Cell Disease: Iron Overload Is Under-Recognized And Under-Managed, Matthew Sears, Phd, Sophie Lanzkron, Md, Mhs, Carolyn Hoope, Md, Joshua J. Field, Md, E. Leila Jerome Clay, Md, Mcts, Faap, Susan Padrino, Md, Payal C. Desai, Md, Lynne D. Neumayr, Deepa Manwani, Md, Jane Little, Md

Phase 1

Introduction: GRNDaD is a prospective registry for people with SCD that opened to enrollment in 2016. Nine comprehensive SCD centers from across the United States are currently enrolling patients. The registry includes iron status and management data, important in SCD because chronic transfusion therapy is a mainstay of prophylactic management. Each unit of transfused blood introduces approximately 250 mg of iron into the blood, which can lead to systemic iron deposition, and untreated may lead to organ dysfunction or death.

Methods: GRNDaD currently contains prospective baseline and annual update information on approximately 1000 people with SCD. We analyzed ferritin levels …

Evaluating Cardiac Anatomy As A Predictor For Success After Pulmonary Vein Isolation For The Treatment Of Atrial Fibrillation, Paul Richter, Evan Rochlis, Ethan Halpern

Phase 1

Introduction: Atrial Fibrillation is a condition characterized by the production of ectopic beats by the heart. One common treatment for Atrial Fibrillation is catheter guided pulmonary vein isolation (PVI), however this treatment is only effective in around 60-70% of the population. Our research hopes to elucidate a link between cardiac anatomy and successful treatment of A-fib by pulmonary vein isolation.

Methods: The medical records for 78 consecutive patients who underwent PVI for atrial fibrillation at Jefferson from July 2013 to March 2016 were gathered. Included in these charts were ECG-gated cardiac CT angiogram and two-year follow up history. Different variables …

Vaccination Exemptions For School-Aged Children In Delaware, Anna Melnick, Mph, Meghan Gannon, Phd

Phase 1

Background: Current awareness around childhood vaccinations and associated requirements for school entry has been heightened both nationally and internationally as governments work to find a balance between protecting their residents’ health and personal freedoms. Scant research exists examining the characteristics of these vaccine exemptors, but as the percentage of students seeking these exemptions increases yearly, this yields an opportunity to identify trends and inform future policy.

Question: What are the associations between reason for exemption from mandated vaccinations and the demographics of race and gender for school-aged children in the state of Delaware?

Results: Drawing from school nurse vaccine exemption …

Functional Outcomes After Lumbar Fusion In Opioid-Tolerant Patients, Max Detweiler, Noah Levy, Dhruv K.C. Goyal, Ariana Reyes, Alex R. Vaccaro, Md, Phd, Mba

Phase 1

Introduction: Prolonged opioid use after lumbar fusion surgery is implicated with increased hospital readmissions, higher postoperative pain scores, and longer return to work time. There are several non-modifiable risk factors for postoperative opioid use including socioeconomic status and gender. The purpose of this study was to determine the effects of opioid-tolerance on PROMs and to determine risk factors for prolonged opioid use after lumbar spine surgery.

Method: Using retrospective cohort analysis, patients who underwent lumbar spinal fusion at TJUH were identified and determined to be either opioid-naïve or opioid-tolerant using the Pennsylvania PDMP. Outcomes included number of opioid tablets consumed, …

Emergency Medicine Palliative Care Access (Empalla): Preliminary Data From A Multi-Center Randomized Controlled Trial, Abigail M. Schmucker, Ba, Deborah J. Shim, Bs, Corita R. Grudzen, Md, Mshs, Jeanne Cho, Mph, Keith Goldfeld, Drph

Phase 1

Introduction: Emergency department (ED)-initiated palliative care has been shown to improve patient-centered outcomes in older adults with serious illnesses, but the optimal modality for providing such interventions is unknown. The EMPallA trial compares nurse-led, telephonic case management with specialty, outpatient palliative care on: 1) patient quality of life (QOL); 2) healthcare utilization; 3) loneliness and symptom burden; and 4) caregiver strain, QOL, and bereavement.

Objective: Summarize preliminary demographic and QOL data for the EMPallA cohort.

Methods: A pragmatic, parallel, two-arm randomized controlled trial is enrolling 1350 ED patients across 9 EDs over 3 years to compare the effectiveness of palliative …

Direct Anterior Approach Utilizing A Bikini Incision Has Less Wound Related Complications In Patients With High Bmi, Taylor Paskey, Bs, Jorge Manrique, Md, Majd Tarabichi, Md, Camilo Restrepo, Md, Carol Foltz, Phd, William J. Hozack, Md

Phase 1

Introduction: Direct anterior approach (DAA) total hip arthroplasty (THA) can be performed through a traditional vertical skin incision, situating the proximal incision at the hip flexion crease, or a horizontal (bikini) skin incision, situating the incision slightly distal and parallel to the hip flexion crease. The dissection beyond the subcutaneous layer is identical for both methods.

Objective: The purpose of this study was to compare these approaches, performed by an experienced single surgeon, in terms of overall wound complications and patient-reported esthetics 6-months post-operatively. It was hypothesized that the bikini incision would result in less wound complications and …

Repeat Neuro-Imaging In Patients Presenting With Traumatic Extra-Axial Intracranial Hemorrhage, Austin Saline, Anthony Stefanelli, Md, Omaditya Khanna, Md, Sol Feuerwerker, Somnath Das, Evan Selzer

Phase 1

Introduction: The management of extra-axial intracranial hemorrhage patients is complicated and lacks a systemic algorithm to determine the timing and necessity of head computed tomography (HCT). However, repeat HCTs weakly predict the need for an intervention after mild traumatic brain injury (TBI).

Objective: This study focused on assessing the safety, efficacy, and necessity of obtaining serial HCTs in patients presenting with subdural hemorrhages.

Methods: A retrospective chart review was conducted of patients with subdural hemorrhages and a GCS between 13-15 on admission (n=116). The total number of HCTs, time between repeat HCTs, duration of hospital stay, and factors necessitating surgery …

Sociodemographic Background Characteristics Of Patients Who Participate In A Lung Cancer Screening Program, Amber Zhang, Marcella Pimpinelli, Brooke Ruane, Russell K. Mcintire, Julie Barta, Md, Hee-Soon Juon, Bridget Jackson

Phase 1

Introduction: Despite decreasing lung cancer incidence and mortality rates, disparities in prevalence and outcomes persist between Black and White patients. Secondary analysis of the National Lung Screening Trial found screening with low-dose CT (LDCT) reduced lung cancer mortality more in Blacks than Whites. However, it is unknown if racial disparities exist in screening results, and the involved sociodemographic factors.

Objective: The study aims to analyze characteristics that may predict screening outcomes (Lung-RADS category) in patients who received LDCT through the Jefferson Lung Cancer Screening Program (LCSP).

Methods: Retrospective data (n=733, May 2015 to July 2017) were merged with prospective …

Knowledge, Attitudes, And Beliefs About Sexual Health And Behavior In Huye, Rwanda, Sara Charles, Lianna Drobatz, Ryan Dorey

Phase 1

Introduction: Pregnancy and its associated complication is the leading cause of death for women aged 15-19 worldwide. Teenage pregnancy is correlated with increased health complications, death, poverty, and societal stigma. Pregnancy in Rwanda has been documented at rates of 7% among teen women.

Objective: The objectives of this research study include assessing the attitudes, knowledge, and beliefs of adolescents in the Huye District of Rwanda regarding sexual health and behavior. We hypothesize that gaps in sexual health knowledge may exist and that differing beliefs among male and female adolescents affect adolescent sexual decision making, and, therefore, teenage pregnancy prevalence.

Methods: …

More Social Needs Endorsed By Caregivers Of Young Children Experiencing Everyday Discrimination, Elizabeth Critchlow, Jennifer Robbins, Md, Mph, George Datto, Md, Tirzah Spencer, Phd, Diane Abatemarco, Phd, Msw, Thao-Ly Phan, Md, Mph

Phase 1

Background: Both discrimination and social needs are underlying risk factors for poor health outcomes; however, there are no studies looking at how feelings of discrimination impact reporting of social needs in the pediatric health care setting.

Objective: To compare caregiver report of social needs and desire for help addressing social needs in the pediatric primary care setting based on respondents’ experiences with discrimination.

Methods: We conducted a cross-sectional study of caregivers of children aged 2-5 in an urban primary care setting. Caregivers completed a tool to screen for 15 social needs and desire for help to address these needs, with …