Medicine and Health Sciences Commons^™

Uncalibrated Chronotypes: Circadian Clocks In The Wake Of Covid-19, Nicolas Nelson, Zachary Highley-Gergel, Nicole Simone, Nikolaos Mouchtouris, Adam Dicker

Phase 1

Background: All life is attuned to Earth’s light–dark cycle. In humans, the hypothalamus calibrates the body to circadian cycles of homeostatic activity. The mechanism responsible may run shorter or longer than 24 hours, which is thought to be the basis of chronotype—an intrinsic preference for mornings or evenings. Circadian rhythms can be recalibrated by environmental cues (lighting, temperature, mealtimes) to keep the body aligned with societal time; however, chronic disruptions produce a range of adverse cognitive effects. Early COVID-19 stay-at-home conditions were unique for students because their cues no longer adhered to strict scheduling. Our objective was to determine how …

Paging: A Collection Of Short Stories, Shruthi Deivasigamani, Katherine Hubbard, Ma

Phase 1

Introduction: Paging is a series of thematically interconnected short stories that take place at a single fictional urban hospital center. The guiding questions that the stories explore are twofold: other than doctors and patients, what kinds of people spend their time in a hospital? And, what kind of place is the hospital for these people?

Methods: The background research for Paging began by exploring written works of fiction, nonfiction, and memoir set in hospitals. After I had developed a set of guiding research questions, I spent the summer at a major hospital in New York City, where I was able …

Investigating Chronic Illness In Pathways To Housing Clients, Joshua Malerich, Lara Weinstein, Md, Dph

Phase 1

Approximately 553,000 individuals were homeless in the US each night in 2017, each at significant risk for substance use disorder, severe mental illness, and untreated chronic disease. Housing First (HF) is an evidence-based model for reaching high risk homeless individuals by providing a personal home to clients without the requirement for abstinence. HF has been shown as effective as other frameworks in remission of substance use, connectedness in the community, and client perceived quality of life, but there is a gap in the literature regarding the impact of HF services on clinical measures of chronic health, which could help further …

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 …

Improvements On The Inhaler, Jesse Evensky, Bradley Freid, Kabir Malkani, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: Inhalers are a commonplace in American health care and deliver crucial drugs to patients with COPD and asthma. Inhaler use has been shown to be unsatisfactory among patients resulting in ineffective medication delivery. The goal of this project was to improve the inhaler design for increased effectiveness and ease of use.

Methods: Our team first interviewed a Pulmonologist regarding patient inhaler use. Dr. Harry Kane demonstrated the proper use of an inhaler as well and described errors in inhaler use are due to patient technique. A variety of inhalers currently available were examined and were compared for ease of …

Color-Changing Device To Improve Adherence To Foley Catheter Replacement Protocols And Reduce Urinary Tract Infection Frequency, Kurt Hill, Alexander Straus, Ms, Bryn Cross, Jason M. Fields, Md

Phase 1

Background: Foley catheter-associated UTI’s (CAUTI’s) represent a driving cause of cystitis, bacteremia and sepsis in the hospital setting. Accordingly, the CDC has identified prolonged indwelling time as the foremost risk factor for CAUTI’s. However, the fundamental design of the Foley has remained unchanged for over eighty years. Hospital-specific protocols do currently exist for the removal of infection-prone catheters; however, in practice it remains commonplace for catheters to be ignored, increasing the risk of life-threatening infection. Our design process addressed this by creating a color-changing alarm device that would alert providers when a catheter has been left in beyond protocol, is …

Helping Continuing Care Retirement Communities Determine The Best Level Of Care For Each Patient, Austin Klein, Nicholas Safian, Grant Schultheis, Sopuru Ezeonu, Danielle Snyderman, Md

Phase 1

Background: The vast majority of healthcare costs are spent on the last decade of life. Older patients often have complex medical histories complicated further by physical, mental and social limitations. High levels of hospital readmittance and nonadherence further complicate care for senior adult patients. Continuing Care Retirement Communities (CCRCs) are long term care facilities that attempt to support this diverse array of problematic patients. Residents can live in several different groupings called “Levels of Care” (LOC). To maximize safety, quality of care, and patient satisfaction, it is important to place residents in the right context. This project seeks to drive …

Creating A Noise-Reducing, Wearable Intervention For Newborns In The Nicu, Mohammad Rasool, Alexandra A. Mccullough, Alison Romisher, Robert S. Pugliese, Pharmd, Bcps, Bon Ku, Md, Mpp

Phase 1

Background: Excessive auditory stimulation can have negative effects on the growth and development of newborn babies. The American Academy of Pediatrics states that newborns should not be exposed to sounds in excess of 45dB while they are in the hospital, however noise levels in NICUs across the country are often between 50-100dB. A design project was conducted to develop an intervention that could reduce infant exposure to excessive noise.

Methods: Neonatologists, nurses, audiologists, music therapists, sound designers, soft materials experts, and medical device designers were interviewed and consulted throughout the design process. A 24-hour sound recording using a REED-SD-4023 meter …

Improving The Inhaler, Kabir Malkani, Jesse Evensky, Bradley Freid, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: It is estimated that about 1 in 10 Americans use inhalers to deliver inhaled drugs for respiratory disease such as COPD and asthma. Some studies have shown that up to 84% of people use their inhaler incorrectly, which can cause long term problems and acute flareups. Therefore, improving the inhaler design to allow for ease of use was the main focus of our project.

Methods: We had a discussion with a pulmonary critical care attending who provided information on proper patient inhaler use and common user errors. He also gave us a sample of different inhalers on the market …

Applying Design Thinking For Community-Provider Collaboration: Designing A Culture- And User-Friendly Refugee Wellness Center, Oluwatoni Okuboyejo, Ellen Solomon, Shandon Coffman, Brandon Joa, Bon Ku, Md, Mpp

Phase 1

Background: Designing South Philadelphia’s first permanent healthcare facility dedicated to immigrant and refugee health presents a unique opportunity to integrate cultural sensitivity with principles of community health. Philadelphia is a city saturated with many medical institutions and hospitals, yet there are large health disparities within miles of each other. Bringing together healthcare providers with a common goal of improving community health needs from a cultural standpoint can be tasking, even when all are on the same page. Design thinking is an underexplored perspective that has the potential to address these concerns in an efficient way that improves both provider and …

3d Printed Liver Models As A Tool To Improve Pre-Surgical Consultation And Enhance Patient Consent, Miranda Sill, Nathan Ott, Robert S. Pugliese, Pharmd, Bcps

Phase 1

Background: 3D printing has recently emerged as an effective, cost-efficient tool for healthcare innovation. We propose the fabrication of 3D printed, patient-specific liver models as a pre-surgical planning and communication tool for liver resection surgery.

Methods: Creation of the model began with the segmentation of the patient's abdominal CT scan, where specific sections of their anatomy, including the blood vessels (portal and hepatic systems), gallbladder, and tumor (when applicable), were digitally segmented. Each structure was then printed in a unique color using polylactic acid (PLA) plastic filament on an Ultimaker 5s printer. Once printed the components were arranged anatomically and …

Patient Interview Simulator: An Innovative Tool To Learn And Practice Clinical Medicine, Daniel Habbal, Khaled Noueihed, Gretchen Diemer

Phase 1

Purpose: There is a lack of materials for simulating and testing the medical diagnostic procedure. Studies show that this is a trend nationwide, where not enough emphasis is put on clinical skills acquisition and assessments. We have designed a simulator to supplement the integration of medical knowledge in clinical scenarios. We designed this tool to be used as an add-on to medical school curricula.

Methods: Twenty second-year medical students participated in this innovative project, as they had the necessary foundations of medical knowledge, and have not had many patient interactions yet. During the pilot study, participants played four cases regarding …

The Effect Of Display Size On Ultrasound Interpretation, Jamie L. Huot, Mark Magee, Arthur Au, Lillian Flashner, Kelly Goodsell, Resa E. Lewiss, Zachary Risler

Phase 1

Purpose: To assess how display size affects providers’ abilities to accurately interpret ultrasound (U/S) videos. U/S has become essential for patient evaluation in the emergency setting. Although newer devices that are smaller in size and affordable place the technology within the pockets of practitioners, it is necessary to assess how smaller size may impact image quality.

Methods: The target learner population for this study includes all practitioners who perform point of care U/S. A prospective convenience sample of emergency providers were randomized to begin on either a phone-sized screen or a laptop-sized screen. Participants answered "Yes" or "No" in response …

Race And Implicit Bias In The Jeffmd Case-Based Learning Curriculum, Abigail Wetzel, Denine Crittendon, Mph, Rosemary Frasso, Phd, Andres Fernandez, Md, Susan Truong, Md, Traci Trice, Md

Phase 1

Purpose: Race is related to health disparities, not to genetic predispositions, but race is often presented to medical students as a biological variable. At Sidney Kimmel Medical College, the curriculum has never been reviewed to analyze how race is presented to students. This Scholarly Inquiry project aims to analyze how the case-based learning (CBL) narratives presented to medical students perpetuate or challenge implicit biases in medicine, especially in regard to race. This paper will describe the methods of the project, which can serve as a model for other institutions to review their own curricula.

Methods: Thirty-nine CBL cases from the …

Developing An Online Critical Care Electroencephalography Curriculum For Epilepsy And Neurophysiology Fellows, Anne Woehling, Brooke Hancock, Nathanael Lee, Md, Connie Tang, Md, Allyson Pickard, Md, Andres Fernandez, Md

Phase 1

Purpose: This project aims to create an Electroencephalography (EEG) curriculum that synthesizes the teachings of current publications and faculty expertise within a single digital platform. The goal is to remedy the unmet need for a centralized resource for learners to use when learning EEG interpretation.

Methods: The target learner population is epilepsy and neurophysiology fellows. The platform will be accessible from any computer, tablet, or phone, allowing for mobile, self-paced learning to take place. To date, the curriculum outline has been designed with extensive literature review and collaboration from other institutions, and two pilot modules have been completed using the …

Evaluating The Impact Of Kardiamobile On Healthcare Expenditures, Christopher Gerace, Mph, Daniel Frisch, Md

Phase 1

Background: KardiaMobile is a mobile ECG device, with smartphone connectivity, that is able to detect atrial fibrillation (a-fib). The device captures a 30 second reading and an algorithm differentiates a-fib from sinus rhythm. The mobile application can alert the user to an a-fib reading and also send the ECG output to their personal physician. By monitoring a-fib without accessing traditional care, KardiaMobile has the potential to reduce healthcare costs for patients with a-fib. This study looked to evaluate the effect of KardiaMobile on healthcare utilization for patients with suspected or diagnosed a-fib and who see a clinical cardiac electrophysiologist.

Methods: …

Assessment Of A Wearable Device For Minute Ventilation In Detecting Different States Of Ventilation, Michael Morano, Yash Patel, Marc J. Torjman, Phd, Indupriya Eedara, Ms, Moeness Amin, Phd, Channy Loeum, Jeffrey Joseph, Do

Phase 1

Introduction: Minute ventilation (MV) and breathing status are valuable vital signs to measure in patients clinically such as in detecting opioid induced respiratory depression. However, there are few devices capable of continuously monitoring MV in an accurate fashion. RTM Vital Signs, LLC and TJU are developing a non-invasive wearable Tracheal Sound Sensor to determine if a device can accurately and continuously measure respiratory rate (RR), tidal volume (TV), MV, and changes in ventilation patterns based on sound recordings of breathing.

Methods: Tracheal breathing sounds were recorded in six researchers using a prototype sensor placed on the skin above the sternal …

Utilizing The Smart Rooms Device To Improve Patient Experience In Hospitals, Thomas Hurysz, Alison Romisher, Daniel Campbell, Maia Ottenstein

Phase 1

Introduction: Utilizing smart room assistants in a hospital setting has the capacity to improve both the patient and provider experience, as well as improve patient outcomes. Thomas Jefferson University Hospital created the Smart Rooms device, a HIPAA compliant voice assistant, specifically for hospital settings.

Methods: A prospective, cross-sectional study was conducted in 11 rooms on the Methodist Hospital postoperative floor between March 2019 and September 2019 to study the impact of the Smart Rooms device on patient experience. Patients were given a survey using a Likert scale which asked questions about their satisfaction with their stay. During this time, surveys …

Angiogenin Mrna Expression Levels In Prostate Cancer Tissue, Bowen Yao, Megumi Shigematsu, Phd, Kamlesh Ganesh Pawar, Phd, Venetia Pliatsika, Ms, Yohei Kirino, Phd

Phase 1

Introduction: Prostate cancer is the most commonly diagnosed cancer in men and second leading cause of cancer deaths. Studies have shown that tRNA fragments are upregulated in prostate cancers and play important roles in carcinogenesis. This project looks at how tRNA cleaving enzyme angiogenin expression is regulated in prostate cancer tissues.

Methods: Clinical data and mRNA expression levels of selected tRNA cleaving enzymes were extracted from the TCGA website. mRNAs were sequenced using IlluminaGA_RNASeqV2 at University of North Carolina.

Results: 546 samples from 494 patients, with normal tissue from 53 patients were collected. ANG mRNA levels were lower in patients …

Cognitive Changes In Patients Treated For Obstructive Sleep Apnea With Upper Airway Stimulation, Maxillomandibular Advancement, Or Expansion Sphincter Pharyngoplasty, Nicolas Zingas, Colin Huntley, Matthew Stewart, Ramez Philips

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a prevalent diagnosis that has been shown to not only affect sleepiness, but daytime cognitive function — specifically attention, working memory, and executive function. CPAP treatment is troublesome for some patients and it is possible that superior treatment options, specifically novel surgical techniques, are available, though none have been evaluated for their long-term effects on neurocognition. We hypothesize that treating patients with upper airway stimulation surgery (UAS) UAS, maxillomandibular advancement surgery (MMA), and expansion sphincter pharyngoplasty surgery (ESP) for OSA produces a significant improvement in cognition from baseline.

Methods: For inclusion in the study, …

Assessing The Temporality Of Adverse Effects Of Vaccines In The Nicu, Julia Tonnessen, Pedro Urday, Md

Phase 1

Introduction: Premature infants have an increased risk of contracting vaccine-preventable diseases and experience worse outcomes. Evidence supports keeping them on a regular vaccination schedule, but it is often delayed, partly because preterm infants have an increased incidence of cardiorespiratory events compared to term infants. The aim of our study was to determine if immunizations in the NICU contribute to an increased number of adverse events.

Methods: This was a retrospective, single-center, observational study with the target population infants born at less than 32 weeks gestation at Thomas Jefferson University Hospital who received the two-month vaccination series in the NICU. The …

Ageism In Consent? In A Decision-Making Capable Geriatric Orthopaedic Trauma Patient Population, Does Increased Age Impact Who Physicians Consent For Surgical Fixation?, Madeline M. Mcgovern, Michael F. Mctague, Mph, Marilyn Heng, Md, Mph, Frcsc

Phase 1

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Our study examines the consenting process in an orthogeriatric trauma patient population to determine if there is a relationship between increased age at presentation and utilization of health care proxies (HCPs) for surgical procedure consent.

Methods: We retrospectively reviewed medical records of patients aged 65 and older admitted for an operative fracture between 2013 and 2016. Patients were considered decision-making capable if there was absence of history of cognitive impairment prior to surgical consent and if the patients screened negative in …

Evaluating The Utility Of Diagnostic Workups For Biliary Atresia In Neonates With Cholestatic Jaundice Following Prolonged Tpn, Melissa Austin, Zubair H. Aghai

Phase 1

Introduction: Parenteral nutrition associated cholestasis (PNAC) develops in 40-60% of premature infants following TPN for 2-4+ weeks. The incidence of biliary atresia is low and there is a 60-day, post-term window for corrective surgery. There is limited data on both the natural history of PNAC in premature infants following prolonged TPN, as well as the utility of diagnostic tools investigating biliary atresia in these patients.

Methods: A retrospective chart review using EMR data from the Intensive Care Nursey was performed with the following criteria: premature babies diagnosed with cholestasis, born at <1500 grams, and received TPN for 14 days. Ultimately 61 babies met criteria and data was collected and pooled to produce descriptive statistics and graphs describing laboratory trends.

Results: Median gestational age was 26 [IQR 25, …

State-Level Cpr Education Legislation Associated With Higher Survival After Out-Of-Hospital Cardiac Arrest In Older Adults, Megan Barnes, David G. Buckler, Tyler D. Alexander, Marissa Lang, Alexis Zebrowski, Douglas J. Wiebe, Benjamin S. Abella, Brendan G. Carr

Phase 1

Introduction: State-level legislation requiring CPR education prior to high school graduation is associated with an increased likelihood of community-level CPR training. CPR Legislation has also been shown to be associated with increased bystander CPR. We hypothesized that states with CPR Legislation would be associated with higher survival following out-of-hospital cardiac arrest (OHCA).

Methods: Utilizing 2014 Medicare Claims data for emergency department visits and inpatient stays, we identified OHCA via ICD-9-CM code. CPR Legislation data was collected through online statute review. Exposure to CPR Legislation was assessed using the patient state of residence. All disposition categories were considered survival to discharge …

Training The Next Generation Of Family Medicine Providers Through Group Buprenorphine-Naloxone Visits, Krystina Callahan, Lara Weinstein, Md, Erica Li, Md, Sunny Lai, Md, Alexis Silverio

Phase 1

Introduction: The rise in opioid use disorders (OUD) and fatal overdoses highlight the need to expand access to and capacity for treating OUD. Medication Assisted Treatment (MAT), a medication/group visit model, done in the office setting, is an effective remedy for treating OUD. Understanding residents’ perspectives on their clinical training in MAT can inform the design of a more effective and responsive curriculum.

Methods: A qualitative study using group semi-structured interviews with residents in an urban family medicine residency rotating through a federally qualified health center. Interviews centered on strengths and weaknesses of the MAT program, resident likeliness to …

Microbial Keratitis After Penetrating And Endothelial Keratoplasty, Nicolas Dohse, Turner D. Wibbelsman, Sara Rapuano, Kristin Hammersmith, Parveen Nagra, Christopher Rapuano, Zeba A. Syed

Phase 1

Introduction: The purpose of this study is to review the incidence, risk factors, and outcomes of bacterial and fungal keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK).

Methods: The medical records at Wills Eye Hospital were reviewed for all cases of confirmed microbial keratitis following PK or EK performed between May 1, 2007 and September 1, 2018. Charts were examined to obtain demographic information, past ocular history, details of the microbial keratitis, and graft outcomes.

Results:A total of 2100 transplants (1269 PK and 831 EK) were performed in 1864 eyes of 1601 patients. The incidence of microbial …

Diagnostic Accuracy Of Procalcitonin In Differentiating Sepsis From Noninfectious Sirs In Adult Patients With Subarachnoid Hemorrhage, Keshav Choudhuri, Umer Mukhtar, Md, M. Kamran Athar, Md, David Boorman, Ms, Fred Rincon, Md, Matthew Vibbert, Md, Syed O. Shah, Md, Jacqueline S. Urtecho, Md, Jack Jallo, Md

Phase 1

Background: Subarachnoid hemorrhage (SAH) is a frequent diagnosis in the neuro-intensive care unit (NICU) that can result in the development of systemic inflammatory response syndrome (SIRS) and fever. The differentiation between central fever and infectious fever is paramount in order to prevent superfluous diagnostic testing and overuse of empiric antibiotics.

Methods: A prospective chart review study conducted in the NICU between December 2012 and September 2015. Patients with SAH, fever (≥101.0°F) and/or who were SIRS positive and had PCT levels measured were included. The primary outcome was clinical infection defined as any positive culture or infiltrate on chest X-ray within …

Characteristics And Outcomes Of Patients Discharged Directly Home From A Medical Intensive Care Unit, Michele Fiorella, Ms, Preeyal M. Patel, Ann Zheng, Lauren Mcdonnell, Msn, Acnp, Mina Yasuoka, Msn, Erika J. Yoo, Md

Phase 1

RATIONALE: Discharging patients directly from ICUs is an increasingly common practice, largely due to decreased availability of ward beds. The purpose of this study was to describe the population and evaluate the outcomes of patients discharged directly from the MICU.

METHODS: We conducted a retrospective chart review of direct discharges to home from June 2018 to June 2019 from two MICUs. Patients were separated into two groups based on wait time (<24 hours or ≥ 24 hours) between ward transfer order and actual discharge. The primary outcome was 30-day hospital readmission. Risk was adjusted using Mortality Probability Model (MPM-III); ICU workload at admission and discharge was estimated using the nine equivalents of nursing manpower use score (NEMS). Patient characteristics were compared using t-test and Fisher exact or X².

RESULTS: There was no difference in severity-of-illness or admission NEMS between the two groups. Patients who waited <24 hours for discharge were more likely to be admitted from home. Patients who waited ≥24 hours prior to discharge had significantly longer mean hospital LOS compared to those who waited <24 hours (4.63 days vs. 2.65 days, p<0.001). There was no significant difference in 30-day readmission between patients who were discharged after waiting <24 hours vs. waiting ≥24 hours (p=0.70).

CONCLUSION: Patients who returned directly home from the MICU …

Determining The Role Of Surgery In Diagnosis And Treatment Of Primary Cns Lymphoma, Tyler Fox, Michael Baldassari, Lohit Velagapudi, Karim Hafazalla, Christopher J. Farrell, Md, James J. Evans, Md, David W. Andrews, Md, Kevin Judy, Md, Donald Ye, Md

Phase 1

Introduction: Primary central nervous system lymphoma (PCNSL) is a rare entity typically treated with a combination of chemotherapy and radiation. The role of surgery is controversial, and biopsy may be non-definitive or injurious. We review our series of stereotactic and excisional biopsy as well as surgical debulking of PCNSL to quantify overall risk and benefits.

Methods: Patients with biopsy-confirmed intracranial PCNSL were identified from a large singlecenter academic institution between 2012-2018. Preoperative factors and perioperative outcomes were retrospectively reviewed.

Results: A total of 61 cases of PCNSL were identified. Most patients presented with confusion (23.0%), weakness/paralysis (19.7%), and gait disturbance …

Protocol For Ground Glass Opacity, Elissa Goldman

Phase 1

Rationale: Pure ground glass opacities (GGO), identified incidentally or on lung cancer screening, may indicate pre-invasive subtypes of lung adenocarcinoma. These neoplasms typically demonstrate indolent patterns of growth, and Fleischner Society guidelines recommend up to five years of serial imaging. Our aim was to determine the frequency of diagnosed lung adenocarcinoma arising from GGO detected beyond 5 years of CT surveillance.

Methods: We reviewed all pathologic diagnoses of lung adenocarcinoma (n=442) between 2016 and 2018 of a tertiary academic hospital and National Cancer Institute-designated cancer center to identify all cancers that arose from ground glass opacities detected on CT scan. …