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Race/Ethnicity, Gender, Weight Status, And Colorectal Cancer Screening., Heather Bittner Fagan, Ronald E Myers, Constantine Daskalakis, Randa Sifri, Arch G Mainous, Richard Wender

Department of Medical Oncology Faculty Papers

Background. The literature on colorectal cancer (CRC) screening is contradictory regarding the impact of weight status on CRC screening. This study was intended to determine if CRC screening rates among 2005 National Health Interview Survey (NHIS) respondent racial/ethnic and gender subgroups were influenced by weight status. Methods. Univariable and multivariable logistic regression analyses were performed to determine if CRC screening use differed significantly among obese, overweight, and normal-weight individuals in race/ethnic and gender subgroups. Results. Multivariable analyses showed that CRC screening rates did not differ significantly for individuals within these subgroups who were obese or overweight as compared to their …

Patients Who Request A Female Psychotherapist, Timothy C. Smith, Md, Melinda Fudge, Md, Salman Akhtar, Md, Steven Samuel, Phd

Jefferson Journal of Psychiatry

Upon arriving at an outpatient clinic, many patients request to see a female psychotherapist. Yet little has been written on this topic. The aim of this study was to explore the demographic and clinical characteristics of such patients. We compared patients who voiced a preference for a female therapist with controls on the demographic variables of age, sex, race, marital and financial status and the clinical characteristics of diagnosis, history of sexual abuse, sexual preference, overt presence of sexual or social difficulties, history of prior treatment, gender of the previous therapist, and treatment drop out rate. A chi square analysis …

Sexual Side Effects Of Psychiatric Medications In Women: A Clinical Review, Laura L. Post, Md, Faacs

Jefferson Journal of Psychiatry

Sexual side effects of psychiatric medications have been estimated to occur in 60% of male clients (1) and 30% of female clients (2). Despite a body of literature relating individual medications to specific sexual side effects, few studies have satisfactorily addressed the psychotropic-induced sexual dysfunctions in women. The spectrum of known sexual sided effects resulting from psychopharmacologic interventionswill be reviewed. Guidelines for appropriately addressing the possibility of sexual side effects within a therapeutic relationship for maximizing reporting of sexual side effects, and for possible treatment approaches to sexual side effects will be described.

The Diagnosis Of Multiple Personality Disorder, Joshua D. Mcdavid, Md, Mph

Jefferson Journal of Psychiatry

This paper represents an attempt to facilitate the clinician or psychiatrist in making a diagnosis of Multiple Personality Disorder, the most severe of the dissociative disorders. Emphasis will be placed on detecting signs, symptoms, and information that occur within the constituent parts of a typical psychiatric interview, and that are highly suggestive of MPD even in the absence of alter presentation.

Theme And Content Of Delusions In Asian Indian Psychotic Patients: Correlation With Diagnosis, Christopher Linskey, Md

Jefferson Journal of Psychiatry

The aim of this study was to investigate the types of delusions present in Asian Indian psychotic patients and evaluate correlation with patient diagnosis. Delusional narratives were collected from 50 Indian patients with schizophrenia or an affective disorder. These narratives were judged for delusional theme and content and were correlated with DSM-III-R diagnoses. Using simple categorical analysis, delusional themes of grandiosity and guilt correlated with affective diagnoses. Delusional themes of reference and Schneiderian types were more often associated with schizophrenia. These findings support the concept that delusional themes can be used as valid diagnostic clues in the assessment of psychotic …

The Psychoanalytic Approach To Bulimia, Doris Mirowski, M.D.

Jefferson Journal of Psychiatry

BULIMIA: PSYCHOANALYTIC TREATMENT AND THEORY

Harvey J. Schwartz, M.D., Ed.

International Universities Press, Inc., Madison, CT.

1990 (second edition), 549 pages, $65.00.

Little Elephant Learns About Sex, Judith Watt, M.D.

Jefferson Journal of Psychiatry

WHERE BABIES COME FROM

Stories to Help Parents Answer Preschoolers Questions About Sex

Martin Silverman, M.D. and Harriet Ziefert

Illustrated by Claire Schumacher Random House Press

1989, $19.00

Women's Psychology, Jodi Halpern, M.D.

Jefferson Journal of Psychiatry

FEMALE PSYCHOLOGY, AN ANNOTATED PSYCHOANALYTIC BIBLIOGRAPHY

Edited by Eleanor Schuker, M.D., and Nadine A. Levin son, D.D.S., F.A.C.D.

New Jersey, The Analytic Press

1991, pp.678

Neuroleptic Malignant Syndrome: Diagnostic Dilemma In The Medically Ill, Mahmoud A. Parsa, M.D., Andrew J. Picken,, Robert Keating, M.D.

Jefferson Journal of Psychiatry

Neuroleptic malignant syndrome is a potentially fatal complication of neuroleptic treatment. It is characterized by a variery of signs and symptoms associated with autonomic instability, and hypothalamic and extrapyramidal dysfunction. Since other medical disorders may mimic its clinical presentation, the accurate recognition of this syndrome in the medical setting is often a diagnostic dilemma. Three medically ill patients with a clinical presentation suggestive of neuroleptic malignant syndrome are presented here. The authors discuss the complexity of making the diagnosis, and offer a brief review of the literature.

Cognitive Information Processing In Borderline Personality Disorder: A Neuropsychiatric Hypothesis, J.Wesley Burgess, Ph.D., M.D.

Jefferson Journal of Psychiatry

Neurocognitive information processing was compared in 18 borderline subjects and 14 controls of similar age and gender. An 11-item screening examination significantly differentiated the two groups (P < 0.001). Significant differences were found on Delayed Memory, Serial Sevens, Rhythm Reproduction, and Perseveration subtests (P < 0.05). The results are interpreted as evidence for mild frontotemporal brain deficits. The findings support a developmental model of borderline disorder where early stress/injury during the childhood period of frontotemporal vulnerability results in failure to negotiate developmental landmarks and adult deficits in cognition, emotion/behavior modulation, and insight.

Postenucleation Adjuvant Chemotherapy With Vincristine, Etoposide, And Carboplatin For The Treatment Of High-Risk Retinoblastoma., Swathi Kaliki, Carol L Shields, Sanket U Shah, Ralph C Eagle, Jerry A Shields, Ann Leahey

Wills Eye Hospital Papers

BACKGROUND: Analysis of 52 eyes with high-risk retinoblastoma managed with postenucleation adjuvant chemotherapy using vincristine sulfate, etoposide phosphate, and carboplatin showed no evidence of systemic metastasis in any case during a mean (range) follow-up of 66 (12-202) months.

PURPOSE: To determine the efficacy of postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin in the prevention of metastasis for patients with high-risk retinoblastoma.

METHODS: Retrospective, nonrandomized, interventional case series of 52 eyes in 51 patients with high-risk retinoblastoma consisting of tumor invasion into the anterior segment, posterior uvea 3 mm or greater, postlaminar optic nerve, or any combination of posterior uvea …

Predictors Of Appropriate Defibrillator Therapies- A Single Center Analysis, Rina R. Shah, Ratika Gupta, Carrie Stackhouse, Robin Ward, Behzad B. Pavri

Division of Cardiology Faculty Papers

Discussion:

• Although differences in HR and the JT interval were statistically significant in patients who received appropriate shock vs. those who did not, these differences are not clinically meaningful
• We did not identify any clinical predictors of early vs. late ICD shocks
• These data suggest that we may not be able to improve on current guidelines for patient selection for ICD implantation.

Saddle Pulmonary Embolism: Is It As Bad As It Looks? A Community Hospital Experience., Alejandro Sardi, Jill Gluskin, Adam Guttentag, Morris N Kotler, Leonard E Braitman, Michael Lippmann

Division of Pulmonary and Critical Care Medicine Faculty Papers

BACKGROUND: Saddle pulmonary embolism represents a large clot and a risk for sudden hemodynamic collapse. However, the clinical presentation and outcomes vary widely. On the basis of the findings of right heart dysfunction on echocardiograms, computed tomography angiography, or cardiac enzyme elevation, some argue for the use of thrombolytics or catheter thrombectomy even for hemodynamically stable patients.

OBJECTIVE: To investigate the outcomes and management of patients with saddle pulmonary embolism, including radiographic appearance (estimate of clot burden) and echocardiographic features.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: This study is a retrospective evaluation of all patients with computed tomography angiography positive …

United States Medicine, Women And Jefferson Medical College, Michael Angelo, Matt Varrato

50 and Forward: Posters

Poster with timeline from 1824 to 2008 highlighting contributions to Medicine by women in the United States and Jefferson Medical College.

Leah Lowenstein, Md Nation's First Female Dean Of A Co-Ed Medical School (1981), Michael Angelo, Matt Varrato

50 and Forward: Posters

Poster highlighting Leah Lowenstein, MD the nation's first female Dean of a co-ed medical school. Though last to admit female students, Jefferson Medical College was the first co-educational medical school to appoint a woman as dean.

First Female Students Admitted To Jefferson Medical College, Michael Angelo, Matt Varrato

50 and Forward: Posters

Poster highlighting the first female students admitted to Jefferson Medical College in 1961. On June 6, 1960, the Board of Trustees voted to admit women to Jefferson Medical College. The first woman accepted was 21-year-old Nancy Szwec who also won a scholarship.

Flexner Report: Medical Schools Are Evaluated, Michael Angelo, Matt Varrato

50 and Forward: Posters

Poster highlighting the Flexner Report, Jefferson Medical College and contributions of women including Lolita Pannell, PhD, Sonia Schorr, Elizabeth M. Bogardus, MD, Vera (Easling) Dettweiler, MD and Evelyn D. Schmidt, MD.

Elizabeth Blackwell, Md Nation's First Female Physician, Michael Angelo, Matt Varrato

50 and Forward: Posters

Poster highlights British-born Elizabeth Blackwell (1821-1910) and important years for Jefferson Medical College and women (1849, 1850, 1869, 1891 and 1894.

Alcoholic Cardiomyopathy: A Review., Anil George, Vincent M Figueredo

Division of Cardiology Faculty Papers

Alcohol abuse can cause cardiomyopathy indistinguishable from other types of dilated nonischemic cardiomyopathy. Most heavy drinkers remain asymptomatic in the earlier stages of disease progression, and many never develop the familiar clinical manifestations that typify heart failure. We review the current thinking on the pathophysiology, clinical characteristics, and treatments available for alcoholic cardiomyopathy. The relationship of alcohol to heart disease is complicated by the fact that in moderation, alcohol has been shown to afford a certain degree of protection against cardiovascular disease.

Systemic Adiponectin Malfunction As A Risk Factor For Cardiovascular Disease., Wayne Bond Lau, Ling Tao, Yajing Wang, Rong Li, Xin L Ma

Department of Emergency Medicine Faculty Papers

Adiponectin (Ad) is an abundant protein hormone regulatory of numerous metabolic processes. The 30 kDa protein originates from adipose tissue, with full-length and globular domain circulatory forms. A collagenous domain within Ad leads to spontaneous self-assemblage into various oligomeric isoforms, including trimers, hexamers, and high-molecular-weight multimers. Two membrane-spanning receptors for Ad have been identified, with differing concentration distribution in various body tissues. The major intracellular pathway activated by Ad includes phosphorylation of AMP-activated protein kinase, which is responsible for many of Ad's metabolic regulatory, anti-inflammatory, vascular protective, and anti-ischemic properties. Additionally, several AMP-activated protein kinase-independent mechanisms responsible for Ad's anti-inflammatory …

Challenges And Barriers To Improving Care Of The Musculoskeletal Patient Of The Future - A Debate Article And Global Perspective., Hangama C Fayaz, Jesse B Jupiter, Hans Christoph Pape, R Malcolm Smith, Peter V Giannoudis, Christopher G Moran, Christian Krettek, Karl J Prommersberger, Michael J Raschke, Javad Parvizi

Rothman Institute Faculty Papers

UNLABELLED: ABSTRACT:

BACKGROUND: With greater technological developments in the care of musculoskeletal patients, we are entering an era of rapid change in our understanding of the pathophysiology of traumatic injury; assessment and treatment of polytrauma and related disorders; and treatment outcomes. In developed countries, it is very likely that we will have algorithms for the approach to many musculoskeletal disorders as we strive for the best approach with which to evaluate treatment success. This debate article is founded on predictions of future health care needs that are solely based on the subjective inputs and opinions of the world's leading orthopedic …

The Role Of The Resident On The Psychiatric Inpatient Unit: A Systems Perspective, E. Michael Kahn, Md

Jefferson Journal of Psychiatry

A resident in psychiatry is customarily assigned to inpatient duty for the first year of training. The resident's tasks in this setting are complex, and he' is rarely prepared to perform all of them well (1,2,3). The stress on the resident in this situation is great. Most often, these challenges and their mastery are discussed in terms of intrapsychic conflicts; the traditional remedy is the assignment of a supervisor. Little consideration has be en given to the interpersonal and systems matrices in which these events occur, and the coping techniques and conceptual tools which the resident may use to meet …

Bioethical Issues In The Management Of Gender Dysphoria, George R. Brown, Md

Jefferson Journal of Psychiatry

The term "gender dysphoria" ( I) describes a heterogeneous group of individuals who express varying degrees of dissatisfaction with their anatomic gender (hence "gender dysphoria"), and the desire to possess the secondary sexual characteristics of the opposite sex. Only a minority o f these patients can be considered on the extreme end of a spectrum of subjective dissatisfaction with assigned anatomy and societally sanctioned gender role (i.e., "transsexual"). The number of such patients presenting to psychiatric clinics has greatly increased subsequent to the 1966 publication of Harry Benjamin's seminal work, The Transsexual Phenomenon (2), and extensive media coverage of individual …

The Ideal Psychiatry Training Program: A Resident's Viewpoint, James E. Deming, Jr., Md

Jefferson Journal of Psychiatry

The journey between medical school graduation and specialty board certification in one's chosen field of medicine may comprise the most challenging, exciting and important times of a young professional's life. This journey is called residency education. While the most obvious objectives are cognitive education and practice in the field, trainees also face fundamental life challenges such as developing identity, intimacy and a direction for their own generative goals in the world.

Psychiatry residency should be viewed as a personal as well as professional developmental process (1). It contains all of the turbulence of adolescence revisited (2), where "normative crises" (3) …

Identification Of A Mechanism For Increased Cardiovascular Risk Among Individuals With Low Vitamin D Concentrations., Peter F Schnatz, Matthew Nudy, David M O'Sullivan, Kelly Ethun, Susan E Appt, Thomas B Clarkson

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: The aim of this study was to investigate the plasma concentrations of vitamin D and its association with plasma lipid profiles.

METHODS: Plasma vitamin D3 and lipid concentrations were measured in 119 female cynomolgus monkeys (premenopausal, n = 49; ovariectomized, n = 70) consuming approximately 1,000 IU per day of vitamin D3. In a subset of the ovariectomized monkeys (n = 23), vitamin D3 was remeasured after 6 months. The concentrations of vitamin D3 were analyzed as a continuous variable and were divided at the median into high (≥48 ng/mL) versus low (<48 ng>/mL) groupings.

RESULTS: Among the 119 …

Dynamic Alteration Of Adiponectin/Adiponectin Receptor Expression And Its Impact On Myocardial Ischemia/Reperfusion In Type 1 Diabetic Mice., Yanzhuo Ma, Yi Liu, Shaowei Liu, Yan Qu, Rutao Wang, Chenhai Xia, Haifeng Pei, Kun Lian, Tao Yin, Xiaoyan Lu, Lu Sun, Lu Yang, Yanjie Cao, Wayne Bond Lau, Erhe Gao, Haichang Wang, Ling Tao

Department of Emergency Medicine Faculty Papers

The present study determined the dynamic change of adiponectin (APN, a cardioprotective adipokine), its receptor expression, and their impact upon myocardial ischemia/reperfusion (MI/R) injury during type 1 diabetes mellitus (T1DM) progression, and involved underlying mechanisms. Diabetic state was induced in mice via multiple intraperitoneal injections of low-dose streptozotocin. The dynamic change of plasma APN concentration and cardiac APN receptor-1 and -2 (AdipoR1/2) expression were assessed immediately after diabetes onset (0 wk) and 1, 3, 5, and 7 wk thereafter. Indicators of MI/R injury (infarct size, apoptosis, and LDH release) were determined at 0, 1, and 7 wk of DM duration. …

Relationship Of Adipokines With Insulin Sensitivity In African Americans., Maria P Martinez Cantarin, Scott W Keith, Stephanie Deloach, Yonghong Huan, Bonita Falkner

Department of Medicine Faculty Papers

INTRODUCTION: Cytokines produced by adipose tissue, including adiponectin, have been associated with metabolic abnormalities. The purpose of this study was to examine the relationship of insulin sensitivity measured by euglycemic hyperinsulinemic insulin clamp with plasma adiponectin and other adipokines in young adult African Americans.

METHODS: Participants were healthy African Americans. Anthropometric measures, blood pressure, an oral glucose tolerance test and an euglycemic hyperinsulinemic insulin clamp were performed. Insulin sensitivity measurements were adjusted for percentage of fat mass. Plasma concentrations of adiponectin, plasminogen activator inhibitor-1 (PAI-1) and interleukin-6 (IL-6) were assayed on plasma from fasting blood samples. Pearson correlation coefficients and …

16-Year Trends In The Infection Burden For Pacemakers And Implantable Cardioverter-Defibrillators In The United States 1993 To 2008., Arnold J Greenspon, Jasmine D Patel, Edmund Lau, Jorge A Ochoa, Daniel R Frisch, Reginald T Ho, Behzad B Pavri, Steven M Kurtz

Department of Medicine Faculty Papers

OBJECTIVES: We analyzed the infection burden associated with the implantation of cardiac implantable electrophysiological devices (CIEDs) in the United States for the years 1993 to 2008.

BACKGROUND: Recent data suggest that the rate of infection following CIED implantation may be increasing.

METHODS: The Nationwide Inpatient Sample (NIS) discharge records were queried between 1993 and 2008 using the 9th Revision of the International Classification of Diseases (ICD-9-CM). CIED infection was defined as either: 1) ICD-9 code for device-related infection (996.61) and any CIED procedure or removal code; or 2) CIED procedure code along with systemic infection. Patient health profile was evaluated …

Health-Related Quality Of Life In The Gender, Race, And Clinical Experience Trial., Judith Feinberg, Michael Saag, Kathleen Squires, Judith Currier, Robert Ryan, Bruce Coate, Joseph Mrus

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Background. We report health-related QoL (HRQoL) from GRACE (Gender, Race, And Clinical Experience) study by sex and race over 48 weeks. Methods. 429 treatment-experienced adults (HIV-1 RNA ≥ 1000 copies/mL) received darunavir/ritonavir 600/100 mg twice daily plus an appropriate background regimen. QoL was measured by the Functional Assessment of HIV Infection (FAHI) questionnaire. Results. 67% women and 77% men, including 67.4% black, 76.0% Hispanic, and 73.8% white patients, completed the trial. Baseline total FAHI scores were similar between sexes and races. Total FAHI of the entire population improved by Week 4 (P < .05); near-maximum changes obtained by Week 12 were maintained through Week 48. Women and black patients demonstrated larger improvements in total FAHI versus men, and Hispanic and white patients, respectively. Conclusion. HRQoL improved in all sex and racial/ethnic groups. Sex-based and race-based differences in improvements in FAHI subscales may provide insight into subtle differences of HIV-1 and treatment on HRQoL in different populations.

Appropriate Medication Prescribing In Elderly Patients: How Knowledgeable Are Primary Care Physicians? A Survey Study In Parma, Italy., Vittorio Maio, Pharmd, Ms, Mph, Eric Jutkowitz, Ba, Karina Herrera Ba, Ms, Safiya Abouzaid Pharmd, Giavanna Negri, Pharmd, Stefano Del Canale, Md, Phd

College of Population Health Faculty Papers

What is known and Objective:  Increasing attention is being paid to inappropriate medication prescribing for the elderly. A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy. To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established. This phase aimed to assess primary care physicians' knowledge of appropriate prescribing in elderly patients. Methods:  In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to complete …