Digital Commons Network^™

Literature Review On The Effectiveness Of Poc Lactate Tests For Post-Operative Sepsis Discharge, Blaire Adler, Paarth Jain, Nathan Rim, Rachel Monane

Phase 1

Background: Every year in the USA, there are at least two million surgery-related infections; around 11% are derived from decompression spinal cord surgery. Generally, later detection of sepsis leads to significant burdens on the healthcare system; this manifests financially, temporally, and in poorer patient outcomes. “SepsisCheckToGo” is a toolkit aimed to minimize the number of sepsis complications in spinal surgery patients postoperatively; the kit would include a pulse oximeter, thermometer, and fingertip POC lactate tests to detect early sepsis signs after discharge and before the follow-up visit (which would occur around one month after initial discharge).

Methods: Our team did …

Establishing The Relationship Between Mendelian Nafld And Skin Pathology, Anthony Medvedev, Hassan Vahidnezhad, Phd, Leila Youssefian, Phd, Jouni Uitto, Md, Phd

Phase 1

Introduction:

It is estimated that 25% of the world’s population has some form of Nonalcoholic Fatty Liver Disease (NAFLD), a pathology associated with the development of cirrhosis, varices, and hepatocellular carcinoma. The discovery of a biallelic mutation in ABHD5 established the link between NAFLD and Chanarin-Dorfman syndrome. Consequently, it was hypothesized that additional NAFLD-inducing mutations could be associated with dermatologic manifestations.

Methods:

International NAFLD patients from consanguineous families underwent whole exome sequencing. These results were then filtered by frequency and pathogenicity prediction algorithms (e.g. Mutation Taster, Polyphen, CADD) to yield novel mutations. Concurrently, a literature review via PubMed identified …

Expanding The Whipple Accelerated Recovery Pathway (Warp) To All Patients Undergoing Pancreaticoduodenectomy (Pd), Ava Torjani, Clifford Yudkoff, Taylor R. Kavanagh, Wilbur Bowne, Geoffrey Krampitz, Hamza Rshaidat, Cyrus J. Sholevar, Alexandra C. Leto, William Preston, Elwin Tham, Mandeep Shergill, Shawnna Cannaday, Theresa Yeo, Harish Lavu, Charles J. Yeo

Phase 1

Introduction

Enhanced recovery after surgery constitutes a multi-disciplinary approach to reduce length of stay (LOS), post-operative complications (POCs), and readmission rate (RR). This not only improves patient outcomes, but also reduces hospital costs. The Whipple Accelerated Recovery Pathway (WARP) trial successfully reduced LOS without increasing the rate of POCs and RR in patients undergoing pancreaticoduodenectomy (PD). However, the study was limited to a highly selective group of patients. This study aimed to determine if WARP could be expanded to all patients undergoing PD.

Methods

A single-institution retrospective review of 281 patients who underwent PD between 2017-2020 was conducted. Patients were …

Differences In Clinical And Functional Outcomes Between Osteochondral Allograft Transplantation And Autologous Chondrocyte Implantation When Used In The Treatment Of Focal Grade 3 And Grade 4 Articular Cartilage Defects, Daniel Abraham, Joseph Brutico, Kashyap Chauhan, Anant Dixit, Fotios Tjoumakaris, Brad Tucker, Kevin Freedman

Phase 1

Introduction:

Grade 3 and 4 articular cartilage defects involve 50% of cartilage thickness without involvement of the underlying bone. There are several available options for the surgical repair of articular cartilage lesions including osteochondral allograft transplantation (OCA), a well-established procedure, and autologous chondrocyte implantation (ACI), an alternative developed more recently. Although there are studies examining ACI outcomes, there hasn’t been significant comparison of ACI outcomes to other procedures, including OCA. The inquiry question of this study was: how do clinical and functional outcomes differ between patients with focal articular cartilage defects treated with ACI and patients treated with OCA? …

Impact Of Medical Nutrition Therapy On Blood Pressure, Connor Mcelwee, Jessica Vitale, Cynthia Cheng, Md, Phd

Phase 1

Introduction:

We are studying how Jefferson’s Medical Nutrition Therapy (MNT) program has impacted biometric variables in program participants. These variables include body weight, HgA1C, lipids, and blood pressure (BP). My poster will focus on the impact of Jefferson’s MNT on blood pressure. My hypothesis is that participation in MNT will result in reduced blood pressure.

Methods:

The target population is patients who have participated in Jefferson’s MNT program. Study exclusion criteria included history of gastric bypass surgery, medical conditions or medication usage that might impact weight loss and other dependent variables. Data was abstracted from patients’ medical records, as …

Outcomes Following Open Reduction And Internal Fixation For Distal Humerus Fracture: Does Handedness Matter?, Charlotte N. Shields, Joseph R. Johnson, Jack M. Haglin, Sanjit R. Konda, Md, Kenneth A. Egol, Md

Phase 1

Introduction: No studies have assessed the relationship between extremity dominance and distal humerus fractures. This study sought to compare post-operative outcomes between patients with distal humerus fractures treated by open reduction and internal fixation (ORIF) of their non-dominant vs dominant arm.

Methods: A retrospective review of patients who sustained a distal humerus fracture treated with ORIF at one hospital between 2011-2015 was performed. Data collection included demographics, hand dominance, injury information, and surgical management. Post-operative outcomes included complications, time to fracture union, painful hardware, removal of hardware, Mayo Elbow Performance Index (MEPI), and range of motion.

Results: Of the …

The Use Of Imiquimod For The Treatment Of Empd From The Patients’ Perspective, Darren D'Mello, Paul Chung, Md

Phase 1

Introduction:

Imiquimod is a topical medication used to treat many dermatologic conditions, and it has been used to treat patients with Extra-Mammary Paget’s Disease. There have been case reports that described the effects and outcomes of patients who were treated with Imiquimod, but more research on its use for EMPD must be done. There have been no studies that gathered data from the patients themselves; this is what our study hopes to accomplish. We hypothesize that patients with EMPD who were treated with Imiquimod early after their diagnoses or after surgery had better outcomes than those who did not use …

Validation And Accuracy Of Synovial Alpha Defensin In A Suburban Academic Center After Implantation As Part Of The Workup For Periprosthetic Joint Infections, Donald Willier, Iii, Kenneth J. Mcalpine, Md, Anthony F. De Giacomo, Md, John S. Garfi, Ms, Lawrence M. Specht, Md, Michael S. Kain, Md

Phase 1

Introduction

Periprosthetic joint infection (PJI) is a leading cause of total hip and knee arthroplasty failure. The Musculoskeletal Infection Society (MSIS) criteria for PJI has allowed diagnosis standardization. To increase the MSIS criteria accuracy, synovial fluid biomarkers have been tested. Studies evaluating synovial alpha defensin have reported both sensitivity and specificity up to 100%. In this study, we report our analysis on the use of alpha defensin testing in a suburban academic tertiary referral center.

Methods

We performed a retrospective analysis of a prospectively collected database of 133 patients tested for PJI over a 6 year period. From 2014, our …

Effect Of Recipient Diabetes Status On Immune Rejection After Descemet Stripping Endothelial Keratoplasty, Elliot Cherkas, Zeba Syed, Michael Sulewski

Phase 1

This study seeks to determine whether recipient diabetes status relates to incidence of immune rejection following Descemet Stripping Endothelial Keratoplasty (DSEK). We hypothesized that patients with diabetes would have a greater risk of graft immune rejection.

This is a retrospective cohort study to compare recipient diabetes status in 794 DSEK surgeries at Wills Eye Hospital between January 2008 and July 2019. Kaplan-Meier functions of survival time until first immune rejection was compared between groups. Pearson’s chi square test and Wilcoxon test were used to test the null hypothesis.

During the study period, 146 of 794 DSEK recipients had diabetes. At …

The Impact Of Patient Characteristics On Quality Of Life In Keloid Patients, Jonathan Wang, Romsin Zaya, Rachel Zachian, Mary Metkus, Neda Nikbakht

Phase 1

Introduction: Quality of life (QoL) is an important metric in assessing dermatological diseases such as keloids. This study evaluated the effects of patient characteristics on QoL in keloid patients.

Methods: This was a cross-sectional study. 36 patients presenting to the keloid clinic at TJUH were surveyed. QoL subscale scores for emotion, symptom, and function were calculated in addition to a total score for each patient using a keloid-specific questionnaire. The association between the QoL scores and patient characteristics of sex, ethnicity, as well as keloid location, duration, visibility, size, number, pain score, and pruritis score were evaluated using t-tests. …

Total Knee Arthroplasty In Patients With Prior Meniscus Surgery: A Matched Case Control Study, Lasya Rangavajjula, Steven B. Cohen, Md, Meghan E. Bishop, Md, Shyam Brahmabhatt, Md, Michael G. Ciccotti, Md, Ashley Bassett, Md, Christopher Hadley

Phase 1

Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts.

Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and …

Predictors And Characteristics Of Rib Fracture Following Sbrt For Lung Tumors, Michael P. Carducci, Baskaran Sundaram, Md, Benjamin Greenberger, Md, Maria Werner-Wasik, Md, Gregory C. Kane, Md

Phase 1

See Additional Files section for the abstract.

Predictive Value Of Index Lesion Cross-Sectional Area In Diffuse Large B Cell Lymphoma Patients Treated With Chimeric Antigen Receptor T-Cells, Nicole Winchell, Drew Torigian, Md, Stephen Schuster, Md

Phase 1

No abstract provided.

A Meta-Analysis Of The Effects Of Sglt-2 Inhibitors On Serum Electrolytes, Mark Leibensperger, Jingjing Zhang, Md, Phd, Yonghong Huan, Md

Phase 1

Introduction: Previous studies have reported that sodium-glucose co-transporter 2 (SGLT2) inhibitors affect serum electrolytes levels, especially magnesium. This study aims to integrate direct and indirect trial evidence to evaluate the relative effects of all SGLT2 inhibitors against each other on electrolyte levels in patients with type 2 diabetes (T2D).

Methods: Electronic databases were systematically searched through December 2018 to identify eligible randomized controlled trials (RCTs) that reported mean changes in serum electrolyte levels, including magnesium, sodium, potassium, phosphate, calcium, and urate in patients with T2D. Random-effects pairwise and network meta-analyses were performed to calculate the weighted mean difference (WMD) …

Correlates Of Rem Sleep Without Atonia In Dream Enactment Behavior Associated With Parkinson’S Disease, Nisha Bagchi, Ritu Grewal, Abigail Quintos, Rohin Saroya

Phase 1

Introduction: Parkinson’s Disease (PD), a common neurodegenerative disease worldwide, has few reliable biomarkers. PD has been linked to REM Behavioral Disorder (RBD), a condition where patients abnormally experience REM sleep without atonia (RSWA). We aim to determine whether chin movements, a feature of RSWA, could serve as a PD biomarker. We hypothesize that those with higher RSWA are more likely to have PD.

Methods: Our study examined patients who underwent polysomnograms from 2015 onwards at the Jefferson Sleep Disorders Center. We did a retrospective EPIC chart review and compared 2 groups, those with RBD and PD (n=12) versus RBD …

Coronary Artery Disease And Nonalcoholic Fatty Liver Disease: Clinical Correlation Using Ct Coronary Calcium Scans, Richard S. Kirby, Dina Halegoua-De Marzio

Phase 1

Introduction: Nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) have been explored with coronary angiography which showed a link between severe NAFLD and CVD risk. This study’s aim is to determine if CT coronary artery calcium (CAC) scores used to determine CAD severity in asymptomatic populations can help predict presence of NAFLD.

Methods: Retrospective cross-sectional study of positive CT CAC scores and liver imaging with either CT, ultrasound, or MRI of the abdomen or CT of the chest. Drinking 7 or 14 drinks per week for a woman or man respectively and chronic viral hepatitis diagnosis …

Patient And Renal Allograft Outcomes Of Anticoagulation Therapy In Kidney Transplantation, Rachel Greene, Goni Katz-Greenberg, Md

Phase 1

Introduction: Kidney transplant recipients are often on anticoagulation or antiplatelet therapy, for a variety of indications. These medications are associated with increased risk of bleeding but may reduce risk of thrombosis and possible complications such as allograft loss. The aim of our study is to evaluate the effect of perioperative anticoagulation or antiplatelet therapy on patient and allograft outcomes.

Methods: Data collection was done by retrospective chart review of all patients who underwent a kidney or kidney/pancreas transplantation at Thomas Jefferson University Hospital (TJUH) from 2012-2019. We recorded perioperative anticoagulation and antiplatelet therapy, risk factors for bleeding and thrombosis, …

Treatment Of Distal Radius Fractures In Patients Over 80 Years Of Age: Functional Outcomes After Open Reduction And Internal Fixation Versus Nonoperative Treatment, Robert Gallivan, Lili E. Schindelar, Md, Mph, Richard Mcentee, Pedro K. Beredjiklian, Md

Phase 1

INTRODUCTION

Distal radius fractures are one of the most common fractures seen in the elderly. With the younger physiological age of patients over 60 years, the expectation of functional outcomes is changing. The management of distal radius fractures in the elderly patient, especially those over the age of 80, has not been well defined. The purpose of this study was to compare operative to nonoperative treatment of distal radius fractures in patients older than 80 years to determine if there is any difference in functional outcomes or complications.

METHODS

A retrospective review was performed to identify patients 80 years or …

Development Of A Method Using Retrograde Neuronal Tracers To Neuroanatomically Characterize Respiratory Neural Circuitry, Samantha Thomas, Angelo Lepore

Phase 1

Introduction:

Loss of respiratory function is one of the leading causes of death following spinal cord injury (SCI). Existing studies have demonstrated that pre-phrenic interneurons (PPIN’s) can be recruited into the phrenic motor neuron (PhMN) pathway following cervical SCI and may contribute to respiratory recovery, but there is still a lack of information detailing the nature of these changes and the extent they may improve diaphragm function. This project aims to validate a method of utilizing neuronal tracers to further characterize the intact respiratory circuitry.

Methods:

This study was carried out using a rat model. A fluorophore-conjugated retrograde neuronal …

Sperm Donor Attitudes And Experiences On Direct-To-Consumer Genetic Testing, Sascha Wodoslawsky, Joy Fatunbi, Md, Andrea Braverman, Md

Phase 1

Introduction: Direct-to-consumer (DTC) genetic testing provides a way for genetically linked persons to connect, threatening the anonymity promised by sperm banks to past sperm donors. This study will assess whether these testing resources have changed attitudes of previous donors on donation and their likelihood to donate again.

Methods: A cross-sectional survey was distributed to sperm donors between 1980 and 2020 at Fairfax Cryobank, measuring variables including demographics and donor attitudes on DTC testing. The Qualtrics survey platform aggregated responses and descriptive statistics were used to report outcomes.

Results: Of the 364 responses, 72.8% of donors had not participated …

Abcd Progression Post Crosslinking For Keratoconus, Sonali Patel, Neil Vadhar, Zeba Syed

Phase 1

Introduction:

Keratoconus is a corneal disease that leads to various ocular illnesses such as scarring and thinning and the most common treatment for this disease at this time is Cross Linking. Previously, post-surgical outcomes of cross linking were analyzed using the AK (Amsler- Krumeich) system which didn’t account for posterior corneal surface and corneal thickness. In order to overcome these shortcomings, a new ABCD classification was developed which accounts for anterior (A) and posterior (B) radius of curvature, thinnest corneal pachymetry (C) and distance for best corrected vision (D).

Methods:

A retrospective study was done using 104 patients who …

Cryo Vs Rf P-Wave Characteristics Comparative Analysis, Waleed Khan, Behzad Pavri, John Schanz

Phase 1

Introduction:

Atrial fibrillation is one of the leading causes of heart failure and stroke in the US, meaning that optimizing treatment is essential. There are two catheter based PVI techniques used to treat drug-refractory AF patients: radiofrequency and cryo-balloon ablation. The goal of this study is to determine if there is a difference in efficacy between these two procedures.

Methods:

The study consisted of a retrospective chart review and ECG analysis of approximately 130 patients. The criteria for involvement is patients diagnosed with drug-refractory paroxysmal AF and who have undergone an ablation procedure in the past two years. Baseline characteristics …

Genetic Profiling Of Cell Types In The Pathogenesis Of Nonalcoholic Steatohepatitis (Nash), Yanki Yarman, Raj Vadigepalli

Phase 1

NASH is the progressive form of non-alcoholic fatty liver disease (NAFLD) which affects 25% of adults in the US. We are interested in identifying genetic markers for specific cell populations in the liver and hypothesize that cells undergo genetic reprogramming to handle the molecular stresses of the NASH disease state.

Using previously published single-cell RNA sequencing datasets from mouse liver whole tissue, we identified the top 25 most highly variable genes per cell type in NASH liver tissue. Using R-programming language, datasets from both healthy and diseases livers were deconvoluted, normalized, linearized and dimensionally reduced to create a 3D map …

Use Of Active Comparator Tirals In Dermatology: A Repeated Cross-Sectional Analysis, John Miller, John Barbieri, Md, Arash Mostaghimi, Md, Sophia Ly

Phase 1

Introduction: Spending on medications is expected to grow to $420 billion in 2023, largely driven by introduction of new branded products. While new branded medications can transform how physicians care for patients, others may not offer meaningful benefit over existing less costly alternatives. As additional new products are approved, the need to include active comparators in dermatologic clinical trials is particularly important to guide clinical decision making.

Methods: To evaluate the trends in the use of active comparator trials designs, topical medications approved between January 2002 and December 2020 were identified through the 2020 Food and Drug Administration (FDA) …

Impact Of Long-Term Doula Services On Maternal And Fetal Health Outcomes In Women In Treatment For Opioid Use Disorder, Saloni Parikh, Meghan Gannon, Phd, Msph

Phase 1

This study analyzed the impact of doula services on maternal and fetal health outcomes in pregnant women seeking treatment for opioid use disorder. Understanding the impact of doula services is critical in reducing inequities in health outcomes experienced by this vulnerable population. Retrospective and prospective data was collected from surveys, focus groups, and maternal and infant birth data from 100 women in treatment for opioid use disorder, with fifty utilizing doulas and fifty not utilizing doulas. Standardized data abstraction of quantitative and qualitative measures were collected into an SPSS database and Nvivo, respectively, and analyzed using SPSS. Measures of importance …

Conexo, Joseph Leone, Anjali Patel, Heli Patel, Gigi Geary, Lauren Huggler, Stephanie Szymanski, J. Matthew Fields

Phase 1

Helping healthcare workers keep IV lines clean in order to reduce preventable bloodstream infections.

Maternal Stress And Breastfeeding Intention In Pregnant Women With Opioid Use Disorder, Yassamin Jamshidian, Vanessa Short, Phd, Mph, Diane J. Abatemarco

Phase 1

Introduction: Breastfeeding rates are low among women in treatment for opioid use disorder (OUD). Information on determinants of breastfeeding intention can help inform the design of breastfeeding promotion interventions for this population. The objective of the study was to examine associations between maternal characteristics, including stress, and breastfeeding intention among pregnant women in treatment for OUD.

Methods: Fifty-six pregnant women who were receiving treatment for OUD at Thomas Jefferson University’s Maternal Addiction Treatment Education & Research (MATER) program completed a survey, which included questions on demographics, psychosocial characteristics, breastfeeding history, and breastfeeding intention. Maternal stress was measured using the Perceived …

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 …

Needs Analysis For Breastfeeding Education At Thomas Jefferson University Hospital, Michal Norry, Julia Switzer, Md

Phase 1

Purpose: There are currently gaps in breastfeeding education for OB/GYN and Family Medicine residents, consequently affecting their confidence in this area of patient care. To address this issue, we are conducting an analysis of the efficacy of the current curriculum to highlight areas for future improvement.

Methods: PGY1-4 residents in the departments of Family Medicine (FM) and Obstetrics and Gynecology (OB/GYN) completed a pre-test before their required annual breastfeeding education on August 6, 2020. We used a validated pre-test from the American Academy of Pediatrics (AAP) which included items assessing the training. Learners self-selected one of two didactic sessions: in …

Assessing Sentiment Towards Opioid Use Disorder At Jefferson: Characterizing Non-Clinical Emergency Department Staff, Joseph Arciprete, Benjamin Finard, Madalene Zale, Mph, Benjamin Slovis, Md, Hannah Smith

Phase 1

Purpose: To characterize emergency department (ED) staff regard toward opioid use disorder (OUD) and analyze variation based on job category. The closure of Hahnemann Hospital, in combination with the increasing prevalence of OUD, is exacerbating the previously inadequate network of resources for these patients. Jefferson is strategically positioned to improve the care provided to this patient population, especially in an ED setting, and ultimately increase linkage to long-term recovery programs.

Methods: Sentiment toward this patient population was measured utilizing the Medical Condition Regard Survey (MCRS). This questionnaire was previously validated to subjectively, but quantitatively, assess regard toward a defined patient …