Digital Commons Network^™

Jefferson Digital Commons Quarterly Report: October-December 2014, Daniel G. Kipnis, Msi, Kelsey Duinkerken, Msi

Jefferson Digital Commons Reports

This Jefferson Digital Commons quarterly report will cover the following:

• Assorted statistics
• New assets added to the JDC
• Historical Materials
• What people are saying about the JDC

Merle Gross Salerno Edelstein, Merle Edelstein, Kelsey Duinkerken

First Women at Jefferson Oral Histories

Dr. Edelstein is a psychiatrist and psychoanalyst who works with children, adolescents, and adults. After graduating from Jefferson Medical College in 1965 with the first class of women, she completed her internship at Bryn Mawr and did her residency training in Psychiatry at Hahneman University Hospital and Albert Einstein Medical Center. She did her analytic training at the Philadelphia Association for Psychoanalysis.

Spontaneous Asj-2j Mutant Mouse As A Model For Generalized Arterial Calcification Of Infancy: A Large Deletion/Insertion Mutation In The Enpp1 Gene., Qiaoli Li, C Herbert Pratt, Louise A Dionne, Heather Fairfield, Son Yong Karst, John P Sundberg, Jouni Uitto, Yin Tintut

Department of Dermatology and Cutaneous Biology Faculty Papers

Generalized arterial calcification of infancy (GACI), an autosomal recessive disorder caused by mutations in the ENPP1 gene, manifests with extensive mineralization of the cardiovascular system. The affected individuals in most cases die within the first year of life, and there is currently no effective treatment for this disorder. In this study, we characterized a spontaneous mutant mouse, asj-2J, as a model for GACI. These mice were identified as part of a phenotypic deviant search in a large-scale production colony of BALB/cJ mice at The Jackson Laboratory. They demonstrated a characteristic gait due to stiffening of the joints, with phenotypic similarity …

The Effects Of A Smart Phone App On Hospital Readmission Rates For Patients Diagnosed With Diabetes, Kevin Abercrombie, Mary Bouchaud

College of Nursing Posters

Abstract

Diabetes has been a growing concern in the United States due to the rapidly increasing incidence of this disease over the past decade. In their 2014 report, the CDC reported there were 29.1 million people diagnosed with diabetes in 2012, comprising 9.3% of the total US population. In addition, according to the CDC, 1.7 million people were newly diagnosed with type I and type II diabetes in 2012 with health care costs at an estimated $245 billion. Moving forward, the most effective approach is to empower and educate these patients to self-manage their own disease to decrease or prevent …

Teaching Health Advocacy To Medical Students: A Comparison Study., Julia Belkowitz, Lee M Sanders, Chi Zhang, Gauri Agarwal, Daniel Lichtstein, Alex J Mechaber, Esther K Chung

Department of Pediatrics Faculty Papers

CONTEXT: Many encourage service learning and health advocacy training in medical student education, but related evaluation is limited.

OBJECTIVES: To assess (1) impact of a required community health advocacy training for medical students on student attitudes, knowledge, and skills; (2) student characteristics associated with higher advocacy knowledge and skills; and (3) perspectives of community-based organizations (CBOs).

DESIGN: Cross-sectional surveys.

SETTING: University of Miami Miller School of Medicine (UMMSM) Regional Medical Campus and main campus.

PARTICIPANTS: Medical students at both UMMSM campuses.

INTERVENTION: Required community health advocacy training for first- and second-year students including classroom experiences and hands-on project in partnership …

Dipstick Proteinuria Is An Independent Predictor Of High On Treatment Platelet Reactivity In Patients On Clopidogrel, But Not Aspirin, Admitted For Major Adverse Cardiovascular Events., Carlos D. Davila, Fernando Vargas, Kuan-Hsiang Gary Huang, Thomas Monaco, Anastasios Dimou, Janani Rangaswami, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Abstract The effectiveness of aspirin and clopidogrel in patients with chronic kidney disease (CKD) suffering from acute cardiovascular events is unclear. High on treatment platelet reactivity (HTPR) has been associated with worse outcomes. Here, we assessed the association of dipstick proteinuria (DP) and renal function on HTPR and clinical outcomes. Retrospective cohort analysis of 261 consecutive, non-dialysis patients admitted for Major Adverse Cardiovascular Events (MACE) that had VerifyNow P2Y12 and VerifyNow Aspirin assays performed. HTPR was defined as P2Y12 reactivity unit (PRU) > 208 for clopidogrel and aspirin reaction units (ARU) > 550 for aspirin. Renal function was classified based on the …

Olfactory Function In Migraine Both During And Between Attacks., Michael J. Marmura, Teshamae S Monteith, Waseem Anjum, Richard L Doty, Sarah E Hegarty, Scott W Keith

Department of Neurology Faculty Papers

INTRODUCTION: People with migraine often report being osmophobic, both during and between acute migraine attacks. It is not clear, however, whether such reports are associated with changes in olfaction such as hyperosmia, as measured by psychophysical testing. In this case-control study we quantitatively assessed olfactory identification ability, which correlates with threshold tests of olfactory acuity, in patients with migraine at baseline (no headache), during migraine episodes, and after a treated attack and compared the test scores to those of matched control subjects.

METHODS: Fifty episodic migraine subjects and 50 and sex- and age-matched controls without headache were tested. All completed …

Predictors Of Infections Following Cranioplasty: A Retrospective Review Of A Large Single Center Study., Mario Zanaty, Nohra Chalouhi, Md, Robert M Starke, Rohan Chitale, Md, Shannon Hann, Md, Cory D Bovenzi, Mark P Saigh, Eric W Schwartz, Emily S I Kunkel, Alexandra S Efthimiadis-Budike, Pascal Jabbour Md, Richard Dalyai, Robert H. Rosenwasswer Md, Stavropoula Tjoumakaris

Department of Neurosurgery Faculty Papers

Introduction. The variables that predispose to postcranioplasty infections are poorly described in the literature. We formulated a multivariate model that predicts the risk of infection in patients undergoing cranioplasty. Method. Retrospective review of all patients who underwent cranioplasty following craniectomy from January, 2000, to December, 2011. Tested predictors were age, sex, diabetic status, hypertensive status, reason for craniectomy, urgency status of craniectomy, location of cranioplasty, reoperation for hematoma, hydrocephalus postcranioplasty, and material type. A multivariate logistic regression analysis was performed. Results. Three hundred forty-eight patients met the study criteria. Infection rate was 26.43% (92/348). Of these cases with infection, 56.52% …

Cerebral Arteriovenous Malformations: Evaluation And Management., Norman Ajiboye, Nohra Chalouhi, Md, Robert M Starke, Mario Zanaty, Rodney Bell, Md

Department of Neurosurgery Faculty Papers

There has been increased detection of incidental AVMs as result of the frequent use of advanced imaging techniques. The natural history of AVM is poorly understood and its management is controversial. This review provides an overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management of AVMs. The authors discussed the imaging techniques available for detecting AVMs with regard to the advantages and disadvantages of each imaging modality. Furthermore, this review paper discusses the factors that must be considered for the most appropriate management strategy (based on the current evidence in the literature) and the risks and benefits …

The Career Support Network: An Interdisciplinary Model Integrating Chronic Disease Prevention And Management Programs, Public Health And Occupational Therapy Into A Workforce Development Program For Low Skilled, Low Resourced Individuals, Rickie Brawer, Mph, Phd, Mches, James D. Plumb, Md, Mph, Stephen Kern, Phd, Otr/L, Faota, Robert Walsh, Ms, Otr/L

JCIPE Conference

THE CAREER SUPPORT NETWORK (CSN)

Historical Perspective: What led us to the CSN?

Jeffchat: A Novel Student-Led Extracurricular Ipe Experience Increases Humanistic Approach To Care, Carolyn Giordano, Phd, Steven Fox, Msiv, Jordan Deaner, Msiv, Anna Escuder, Md, Danielle Weber, Md, Kevin J. Lyons, Phd, Elizabeth T. Speakman, Edd, Rn, Cde, Anef, Fnap, Charles Pohl, Md

JCIPE Conference

Presentation Overview

• Overview of JeffCHAT mission, design and implementation strategy

• Presentation of Evaluation Methods and Results

• Interactive Student Panel Discussion

Teaching Teamstepps To Interprofessional Students Or Staff To Promote Teamwork And Patient Safety, Elizabeth T. Speakman, Edd, Rn, Anef, Fnap, Alan Forstater, Md, John Duffy, Msn, Rn, Nethra S. Ankam, Md, Cara Mcdaniel, Pharmd, Lauren Collins, Md, Anne Marie Petit, Msn, Rn, Dimitrios Papanagnou, Md

JCIPE Conference

TeamSTEPPS stands for Team Strategies and Tools to Enhance Performance and Patient Safety.

Should The Entire Team Learn Together? Piloting An Interprofessional, Palliative Care Communication Workshop, Naha Darrah, Md, Diane Hadley, Md, Lora Packel, Md, Varleisha Gibbs, Md, Eunhae Grace Kim, Valerie Cotter, Md, Christine Bradway, Phd, Rn, Zvi Gellis, Md, Cathy Poon, Md, Amy Corcoran, Md

JCIPE Conference

Learning Objectives

To describe the main objective for an effective interprofessional communication workshop

To list the essential elements of an effective interprofessional communication workshop

Extrinsic And Intrinsic Elements That May Impact Students’ Perceptions Of And Willingness To Internalize Interprofessional Education Program Goals, Barret Michalec, Phd, Carolyn Giordano, Brandie Pugh, Ma, Christine A. Arenson, Md, Elizabeth T. Speakman, Edd, Rn, Anef

JCIPE Conference

ABSTRACT

An increasing number of health profession education institutions are constructing and implementing Interprofessional Education (IPE) programs. Various evaluative efforts are therefore underway to explore students’ perceptions of these programs, nuances of the interdisciplinary interactions within programs, and the potential long-term impact of these programs on students’ mentality towards team-based, collaborative care. This study, however, examines how elements specific to and outside of an IPE program may impact students’ perceptions of the program and their willingness to engage with prominent aims and goals of IPE. In-depth, semi-structured interviews were conducted with 16 students from varying disciplines at the end of …

Interprofessional Education: A Curricular Gap Analysis, Janice A. Odiaga, Dnp Cpnp-Pc, Joanne Miller, Phd, Apn/Gpn-Bc, Theresa Gierlowski, Bs, Mpm

JCIPE Conference

The goal of Interprofessional education (IPE) is to create a new health care workforce that is prepared to function as a deliberative culturally competent team, providing patient centered care that optimizes health and quality of life for individuals with multiple chronic conditions. The purpose of an IPE curricular gap analysis is to determine if IPE and key concepts related to chronic disease self-management are integrated into course descriptions, objectives, didactic, activities and evaluated. The baseline results can be an effective tool to initiate an institutional cultural change promoting curricular revision.

Key concept terminology, interprofessional, chronic disease self-management, motivational interviewing, and …

Hearing From Our Health Mentors: Impact Of A Longitudinal Interprofessional Education Program, Ashley Baronner, Bs, Msii, Lauren Collins, Md, Carolyn Giordano, Phd, Edwin Lim, Pharmd Candidate 2015

JCIPE Conference

Introduction

Mixed-methods study to evaluate the perspectives of the Health Mentors in the Jefferson Health Mentors Program (JHMP) relative to impact of program

Correlate these responses to the Interprofessional Education Collaborative’s (IPEC) Competencies

• Values/Ethics
• Roles/Responsibilities
• Interprofessional Communication
• Team and Teamwork

“It’S Persuasion Disguised As Information” The Experiences And Adaptations Of Abortion Providers Practicing Under A New Law, Rebecca J. Mercier Md Mph, Mara Buchbinder, Phd, Amy Bryant,Md,Mph, Laura Britton,Rn, Bsn

Department of Obstetrics and Gynecology Presentations and Grand Rounds

Background

Abortion laws are proliferating in the United States. From 2011 to 2013, 30 states passed a total of 205 abortion restrictions.¹ Increasingly, these laws are focused on abortion providers. Such laws have been criticized by professional organizations including the American College of Obstetricians and Gynecologists,² but few studies have assessed the impact of these laws on abortion providers.

In 2011 North Carolina passed HB 854, the “Women’s Right To Know Act” (WRTK). Similar to laws in 26 other states, WRTK mandates a 24-hour waiting period after counseling before an abortion can be performed. Content of the counseling …

Listing Practices For Morbidly Obese Patients At Liver Transplant Centers In The United States, Dina Halegoua-De Marzio, Md, She-Yan Wong, Md, Jonathan M. Fenkel, Md, Cataldo Doria, Md, Phd, David A. Sass, Md

Division of Gastroenterology and Hepatology Faculty Papers

Introduction

• Obesity affects more than one third of Americans.
• Morbid obesity (body mass index (BMI) >35 kg/m2) has been associated with multiple co-morbidities and perioperative complications.
• The effect of morbid obesity on liver transplant outcomes has yielded mixed results.

Rationale And Design Of The Guide-It Study: Guiding Evidence Based Therapy Using Biomarker Intensified Treatment In Heart Failure., G. Michael Felker, Tariq Ahmad, Kevin J. Anstrom, Kirkwood F. Adams, Lawton S. Cooper, Justin A. Ezekowitz, Mona Fiuzat, Nancy Houston-Miller, James L. Januzzi, Eric S. Leifer, Daniel B. Mark, Patrice Desvigne-Nickens, Gayle Paynter, Ileana L. Piña, David J. Whellan, Christopher M. O'Connor

Division of Cardiology Faculty Papers

OBJECTIVES: The GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) study is designed to determine the safety, efficacy, and cost-effectiveness of a strategy of adjusting therapy with the goal of achieving and maintaining a target N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of

BACKGROUND: Elevations in natriuretic peptide (NP) levels provide key prognostic information in patients with HF. Therapies proven to improve outcomes in patients with HF are generally associated with decreasing levels of NPs, and observational data show that decreases in NP levels over time are associated with favorable outcomes. Results from smaller prospective, randomized studies …

Subgroups Of Cancer Patients With Unique Pain And Fatigue Experiences During Chemotherapy, Heeju Kim, Patrick S. Malone, Andrea M. Barsevick

Department of Medical Oncology Faculty Papers

Context. Some cancer patients experience pain and fatigue, whereas others experience only one of the two symptoms. Yet, it is not clear who experiences these unique patterns and why.

Objectives. This study aimed to identify subgroups of cancer patients with unique pain and fatigue experiences in two different chemotherapy cycles to examine how selected factors influenced subgroup membership and identify how subgroups differed in concurrently measured functional limitation outcome.

Methods. The sample included 276 patients with diverse cancer types from four U.S. sites. To investigate subgroups, latent profile analyses were performed. Multinomial logistic regression and one-way analysis of variance-type analyses …

Isomir Expression Profiles In Human Lymphoblastoid Cell Lines Exhibit Population And Gender Dependencies., Phillipe Loher, Eric R Londin, Isidore Rigoutsos

Computational Medicine Center Faculty Papers

For many years it was believed that each mature microRNA (miRNA) existed as a single entity with fixed endpoints and a 'static' and unchangeable primary sequence. However, recent evidence suggests that mature miRNAs are more 'dynamic' and that each miRNA precursor arm gives rise to multiple isoforms, the isomiRs. Here we report on our identification of numerous and abundant isomiRs in the lymphoblastoid cell lines (LCLs) of 452 men and women from five different population groups. Unexpectedly, we find that these isomiRs exhibit an expression profile that is population-dependent and gender-dependent. This is important as it indicates that the LCLs …

Inferior Meatus Maxillary Antrostomy: Time To Revisit A Previously Abandoned Surgical Technique?, Natalie Ziegler, Bs, Alfred Marc C. Lloreta, Md, Alexander Farag, Md, Ting Ting Zhan, Phd, Gurston G. Nyquist, Md, Marc Rosen, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Background: A small subset of patients have dysfunctional maxillary sinus mucosa. These patients require more aggressive surgical treatment to allow for gravity dependent mucous drainage, intra-operative and office debridements, and the delivery of irrigations and topical treatments. The aim of this study is to examine the use of inferior meatus maxillary antrostomy (IMMA) in combination with traditional maxillary antrostomy, in this challenging patient population.

Methods: We performed a retrospective study from February, 2008 until April, 2014 with a 118 patients undergoing a total of 128 IMMA procedures. Data was gathered regarding patient demographic, prior therapy, post-operative medical therapy, IMMA patency, …

Association Of Leukocyte Mitochondrial Dna Content With Glioma Risk: Evidence From A Chinese Case-Control Study., Jie Zhang, Deyang Li, Falin Qu, Yibing Chen, Gang Li, Hequn Jiang, Xiaojun Huang, Hushan Yang, Jinliang Xing

Department of Cancer Biology Faculty Papers

BACKGROUND: Increasing evidence suggests that alterations in mitochondrial DNA (mtDNA) content may be implicated in the tumorigenesis of several malignancies. However, the association between mtDNA content in peripheral blood lymphocytes (PBLs) and glioma risk has not been investigated.

METHODS: Real-time PCR was used to examine the mtDNA content in PBLs of 414 glioma patients and 414 matched controls in a hospital-based case-control study. The association between mtDNA content and glioma risk was evaluated using an unconditional multivariate logistic regression model.

RESULTS: We found that glioma patients exhibited a significantly higher median mtDNA content than healthy controls (0.99 vs. 0.71, P …

Risk Factors For Surgical Site Infection Following Total Joint Arthroplasty., Mohammad R Rasouli, Camilo Restrepo, Mitchell Maltenfort, Phd, James J Purtill, Javad Parvizi

Rothman Institute Faculty Papers

BACKGROUND: Currently, most hospitals in the United States are obliged to report infections that occur following total joint arthroplasty to the Centers for Disease Control and Prevention through the National Healthcare Safety Network surveillance. The objective of this study was to identify the risk factors of surgical site infections that were reported to the Centers for Disease Control and Prevention from a single institution.

METHODS: For this study, 6111 primary and revision total joint arthroplasties performed from April 2010 to June 2012 were identified. Surgical site infection cases captured by infection surveillance staff on the basis of the Centers for …

Ethanol Pharmacokinetics In Neonates And Infants, Elizabeth Marek, Pharmd., Walter K. Kraft, Md

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Introduction:

Ethanol has been used for years in neonatal and infant liquid medications, yet the pharmacokinetics, pharmacodynamics, and safety of ethanol in this vulnerable population have not been well characterized. The purpose of this review is to raise awareness of ethanol use as an excipient in neonatal and infant medications and to provide insight, based on the available evidence, into clearance rates of ethanol in babies. We also discuss ethanol pharmacokinetics in adults, theoretical pharmaco-kinetic changes in neonates and infants as it may apply to ethanol disposition, and case reports involving ethanol exposure in neonates and infants.

Materials and methods: …

Return To Work After Stroke: A Nursing State Of The Science., Catherine Harris, Phd, Mba, Crnp

College of Nursing Faculty Papers & Presentations

There is a lack of research related to return to work (RTW) after acute ischemic stroke. Historically considered a disease of the elderly, acute ischemic stroke studies have not routinely used return to work as an outcome. Major stroke trials have not routinely collected this data as an endpoint. However, the mean age for acute ischemic stroke (AIS) has declined to 69 years of age, while the incidence in patients under the age of 55 has increased to 19%^1-3. Changes in retirement age have also affected RTW as a consideration in stroke patients. Failure to RTW after recovery …

Randomised Clinical Trial: Polyethylene Glycol 3350 With Sports Drink Vs. Polyethylene Glycol With Electrolyte Solution As Purgatives For Colonoscopy--The Incidence Of Hyponatraemia., Rebecca Matro, Constantine Daskalakis, Dan Negoianu, Leo Katz, Cassandra Henry, Michael Share, David Kastenberg

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Polyethylene glycol 3350 plus sports drink (PEG-SD) is a hypo-osmotic purgative commonly used for colonoscopy, though little safety data are available.

AIM: To evaluate the effect of PEG-SD on serum sodium (Na) and other electrolytes compared with PEG-electrolyte solution (PEG-ELS).

METHODS: We performed a single center, prospective, randomised, investigator-blind comparison of PEG-ELS to PEG-SD in out-patients undergoing colonoscopy. Laboratories were obtained at baseline and immediately before and after colonoscopy. The primary endpoint was development of hyponatraemia (Na/L) the day of colonoscopy. Changes in electrolyte levels were computed as the difference between the lowest value on the day of colonoscopy …

A Double-Blind Randomized Trial Of Fish Oil To Lower Triglycerides And Improve Cardiometabolic Risk In Adolescents., Samuel S. Gidding, Carol Prospero, Jobayer Hossain, Frances Zappalla, Prabhakaran Babu Balagopal, Bonita Falkner, Peter Kwiterovich

Department of Pediatrics Faculty Papers

OBJECTIVES: To determine the efficacy of 4 g/day fish oil to lower triglycerides and impact lipoprotein particles, inflammation, insulin resistance, coagulation, and thrombosis.

STUDY DESIGN: Participants (n = 42, age 14 ± 2 years) with hypertriglyceridemia and low-density lipoprotein (LDL) cholesterol/dL were enrolled in a randomized, double-blind, crossover trial comparing 4 g of fish oil daily with placebo. Treatment interval was 8 weeks with a 4-week washout. Lipid profile, lipoprotein particle distribution and size, glucose, insulin, high-sensitivity C-reactive protein, interleukin-6, fibrinogen, plasminogen activator inhibitor-1, and thrombin generation were measured.

RESULTS: Baseline lipid profile was total cholesterol 194 (5.4) mg/dL (mean …

Steatocystoma Multiplex: Those Little Tumours., Ellen H. De Moll, W. Clark Lambert, Lawrence Charles Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Diverseot: Increasing Diversity Within The Field Of Occupational Therapy, Jocelyn Dressel, Ots, Erin Shervinskie, Ots, Lauren Yaker, Ots

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives of Presentation:

At the end of this session, participants will be able to:

1. Describe the need to increase diversity among occupational therapy professionals

2. Recognize the impact of the absence of diversity within health professions

3. Discuss strategies utilized by other health professions to increase diversity in their student and professional workforce

4. Analyze and adapt effective strategies to increase diversity in the occupational therapy workforce

PICO What are effective strategies to increase diversity among OT students in order to create a diverse workforce?

Note: Handout only, no audio